WAN 35 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 1884. by the MEDICAL OFFICERS OF HEALTH. London: ashfield, steam printer, bridge road west, battersea. 1885. To the Board of Works for the Wandsworth District. Gentlemen, We have the honour to present our Report for the year 1884 on the vital statistics and sanitary condition of the Wandsworth District. In this report, which forms the twenty-ninth of its kind, the same arrangement has been adopted as that hitherto observed, of a separate report for each sub-district, prefaced by a general report on the condition of the entire district, and followed by a series of statistical tables. These, although the last, are by no means the least important part of the report, representing as they do, in a comprehensive and concise form, an amount of important sanitary information, the compilation of which has formed no small task. In spite of the increasing density of its population, the health of the district remains most satisfactory, a fact which must be most gratifying to your Board, and which is calculated rather to ensure an increase of those efforts which have been so productive of good in the past, than to rest content with what has been already accomplished. We have the honour to remain, Gentlemen, Your obedient Servants, The Associated Medical Officers of Health of the Wandsworth District. June 19th, 1885. TABLE OF CONTENTS. Page. Introductory Report on the Health of the Entire District 5 Dr. Kempster's Report for East Batter sea 26 ,, Oakman's ,, West „ 40 ,, Newsholme's ,, Clapham 54 ,, Walker's ,, Putney 67 „ Sutton's ,, Streatham 77 ,, Nicholas' ,, Wandsworth 86 Appendix of Statistical Tables 100—106 special points raised in the local reports. The Certification of Deaths 16,63 High Infantile Mortality 57, 59 Compulsory Registration of Infectious Diseases 11, 61 School Board Regulations respecting Infectious Diseases 19, 92 Causation of Summer Diarrhoea 17, 30, 93 Prospect of Cholera 20, 38, 98 Origin of Diphtheria 62,71 Vaccination and Small Pox 12,41 Condition of the Water Supply 17, 66 Daily removal of House-refuse 19,38 Prohibition of Pig-keeping 64, 97 REPORT, on the HEALTH AND SANITARY CONDITION OF THE ENTIRE DISTRICT, 1884. The particulars contained in the following pages give a general view of the vital statistics and sanitary condition of this district. It will be seen that, although owing to exceptional conditions the zymotic death-rate was somewhat above the average, the total mortality was nearly the same as last year, and the general health of the district was in a satisfactory condition. Further detailed information on matters of local interest will be found in the local reports for the several sub-districts, which immediately follow this general report. VITAL STATISTICS. Population.—The number of persons living in this district during the year 1884, assuming the rate of 6 increase to be the same as during the decade 1871-81, was 238,997, being an increase of 9,431 on the previous year's population. Births—Birth-rate—Bate of Aaturol Increase.—The total births registered during the year numbered 8,979, 4,599 of males and 4,380 of females. The number of births occurring in the several sub-districts will be found compared in Table I., Appendix. The birth-rate calculated from the total births registered and the foregoing estimated population, was 37.57 per 1,000 persons of all ages. The rate of natural increase, represented by the excess of births over deaths, was 19.77 per 1,000. The birth-rate was higher than it had been for four years, and the rate of natural increase than it had been for five years. Deaths, Death-rate.—The total deaths registered during the year numbered 4,266, 2,158 of males and 2,108 of females. The death-rate was 17.85 per 1,000 of the estimated population, giving a slight apparent increase on the previous year's mortality. It should be remembered however that 53 weeks' deaths are included in the returns for 1884, an event which happens every fifth year in order to avoid taking only a portion of the final week into reckoning. If this be allowed for, the death-rate remains almost identical with that of 1883. The birth-rates, death-rates, and rates of natural increase of the past and ten preceding years are exhibited in the following table:— I Birth-rates, Death-rates, and rates of Natural Increase in the entire district during the ten years 1874—83, compared with those of the year 1884. Years. Births. Birth-rate per 1000 Deaths. Death-rate per 1000. Natural Increase. Rate of Natural Increase per 1000. 1874 5221 36.50 2796 19.50 2425 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 3 47 1716 3935 18.51 1882 7889 35.69 3851 17.42 4038 18.26 1883 8079 35.14 4083 17.79 3996 17.39 Mean of Ten Years 1874-83 6684 37.12 3401 18.9 3282 18.18 1684 8979 37.57 4266 17.85 4713 19.77 It will be seen from this table that the death-rate is 1.05 per 1,000 less than the decennial average. It is also 3.75 per 1,000 less than the rate for the 28 great towns, 2'49 per 1,000 less than that for the whole of London, and 1.95 per 1,000 less than that for all the South Districts of London combined. In the case of the whole of London, some small share in producing the low death-rate must be ascribed to the low birth-rate; but in this district, the birth-rate was above the decennial average. The following shews at a glance the great improvement in the mortality of this district since the year 1851, 8 and this notwithstanding the fact that the density of population has been progressively and in the last few years rapidly increasing. 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 „ „ 1884 17.85 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:— SUBDISTRICTS Population in the middle of 1884. Per-centage 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 per cent. of Industrial and other Classes. Industrial Classes Other Classes Battersea 125,091 52.34 2503 20.00 17.75 53.4 83.8 16.2 Clapham 39,632 16.58 543 13.70 No appreciable difference 32.1 46.9 53.1 Putney 14,450 6.04 199 13.70 6.6 56.0 44.0 Streatham 29,149 12.16 445 15.30 8.4 45.1 54.9 Wandsworth 30,675 12.88 576 18.77 14.67 12.4 66.5 33.5 Perhaps one of the most important and hopeful features revealed by this table, is that in Battersea with a population of 53 persons per acre, the death-rate is only 17.75 per 1,000 persons, while in Wandsworth with a population of 12 persons per acre, it is 14.67 per 1000, *This correction is necessary in consequence of the undue exaltation of the deathrates of Battersea and Wandsworth by the mortality of the Union Infirmary and the Bolingbroke Hospital in the former, and of the Surrey County Lunatic Asylum, St. Peter's Hospital, and the Hospital for Incurables, in the latter sub-district. In none of the death-rates in the above table are the deaths occurring in out-lying institutionsiucluded. 9 and in Streatham with a population of 8 persons per acre, 15.3 per 1,000; and similarly in Clapliam with a density of 32 persons per acre the death-rate is 13.7, while in Putney with a density of under 7 per acre, the deathrate is the same. This clearly suggests that the tendency of an increased density of population to be followed by a larger mortality, may be to a great extent counteracted by strict sanitary regulations and supervision. Deaths in Outlying Institutions.—Information of these is obtained from the office of the Registrar General. Their number is 434, the largest proportion of which occurred in the Union Infirmary, the remainder in various Metropolitan and other hospitals. The inclusion of these deaths would raise the death-rate to 19.6 per 1,000. Mortality aud its Causes.—The statistics contained in Table II. in the Appendix, shew the number of deaths and their causes during the past year, while in Table III. these are compared with those of the preceding ten years. Zymotic diseases caused the largest number of deaths, being 19.1 per cent. of the whole, as compared with 17.1 in the previous year. Next to these in fatality were Respiratory diseases, the Tubercular following them with a nearly equal mortality. Epidemic Diseases.—The degree of prevalence of these forms perhaps the best index of the sanitary condition of a district. Under this head the seven principal zymotic diseases are specially referred to. It will be seen from Table IV. in Appendix that during the past year these seven diseases contributed 16.7 per cent. of the total deaths, with a death-rate of 3.02 per 1,000 of the estimated population. This implies a slightly increased mortality from epidemic disease, which is shewn more clearly in a tabular form as follows:— 10 Death-rates of the seven principal epidemic diseases per 1,000 of the population 1878—83, compared with those of 1884. Years. Rate per 1,000. 1878 3.22 1879 3.39 1880 3.20 1881 2.72 1882 2.79 1883 2.63 1884 3.02 Table IV. in Appendix shews at a glance in which zymotic diseases an increase of mortality has occurred during the last year. The most striking increase is in the mortality from Diarrhœal disease, 239 having died as compared with 158 in the previous year. Of these cases 175 occurred in Battersea. The causation of this excessive mortality from Diarrhoea is fully discussed in the report for East Battersea (page 31), and is also alluded to at page 17. Measles caused 182 deaths, 50 more than in the previous year; while Scarlet Fever and Diphtheria, which are taken cognizance of by the sanitary authority as being more serious diseases, only collectively caused 90 deaths, or 38 less than in the previous year. Scarlet Fever and still more Diphtheria and Typhoid Fever are closely associated in their origin with sanitary defects. The reduction in the mortality (and therefore probably in the prevalence) of these diseases is hence a valuable indication of the improved sanitation of the district. The great mortality from Measles may be ascribed to the gross neglect of isolation, and to the exposure to cold and the premature sending of children to school during convalescence. No great reduction in the number of deaths from this disease can be hoped for, until parents become thoroughly alive to its dangers, and 11 the patients are carefully isolated. It is to be hoped likewise that some system of compulsory registration of infectious disease will be found feasible, without which the preventive measures capable of being taken by the sanitary authority, are, owing to defective information, very partial and imperfect. The relative mortality from Epidemic diseases in the several sub-districts is shewn in the following table:— Years No. of deaths from the seven principal epidemic diseases per 1000 of the population. Ratio of deaths from the seven principal epidemic diseases to every 100 of the total deaths. Battersea Claphum Putney Streatham Wandsworth Battersea Clapham Putney Streatham Wandsworth [[/###/ 1878 4.02 3.21 2.24 2.93 1.55 17.8 17.70 13.80 14.70 9.00 1879 4.30 2.40 1.60 1.90 3.50 17.9 14.40 11.10 12.0 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 4.60 110 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 1884 4.58 2.10 1.94 1.82 2.70 20.17 15.28 14.07 12.00 11.10 The Epidemic death-rate was somewhat higher in Battersea than any other part of the district, owing largely to the outbreak of Summer Diarrhoea; though Battersea also presented some preponderance of Whooping Cough and Measles, and of continued Fevers (Typhoid, &c.) In Putney fatal cases of Fever and of Scarlet Fever, were entirely absent, but Diphtheria was somewhat prevalent. The exact distribution of the epidemic diseases may be studied in Table II. (appendix). Vaccination.—The returns of Vaccination for children born during the year 1884 are not yet presented. 12 Those for the previous year are shewn in the following table:— SUBDISTRICTS Number of Births Returned from 1 st. January to 31 st December, 1883. Successfully Vaccinated. Insusceptible of Vaccination. Had Small-pox. Dead, Unvaccinated. Postponed byMedical Certificate. Removed to Districts, Vaccination Officer of which has been duly apprised. Removed to places unknown, or which cannot bo reached; and cases not having been found. Battersea 4734 3870 10 .. 406 63 .. 385 Clapham 1092 903 3 1 95 15 4 62 Putney 352 308 .. .. 27 4 3 10 Streatham 1028 817 3 .. 87 12 .. 109 Wandsworth 915 801 3 .. 55 11 .. 45 8121 6699 19 1 670 105 7 611 It will be seen that of 8,121 children, 6,699 were successfully vaccinated, and that the remainder were accounted for by death, insusceptibility, or postponement on account of illness; except 611, i.e. per cent. During the previous year only 5 per cent were unaccounted for. This considerable proportion of persons unvaccinated constitutes a source of danger to the whole Metropolis, and forms a soil in which Small Poxmay be constantly kept alive in our midst. During the past year 22 deaths of inhabitants of this district were due to Small Pox (including those occurring in the Asylums Board Hospitals). Non-Zymotic Diseases.—In the following table the prevalence of each class of disease is compared with the decennial average corrected for increase of population. 18 CLASSES OF DISEASES. &c. Number of deaths in 1884. Average Annual number of deaths in the ten years 1874-83. Same averages corrected for Increase of population. Number' of deaths 1884 above corrected average. Number of deaths 1884 below corrected average. 1. Zymotic, viz :— Seven principal Epidemic Diseases. Small 9 15 20 .. 11 Measles 182 89 117 65 .. Scarlatina 47 100 132 .. 85 Diphtheria 43 25 33 .. 10 Whooping Cough 145 122 161 16 .. Fever 58 48 63 .. 5 Diarrhœa 239 144 190 49 .. Other Zymotic Diseases 90 70 92 .. 2 2. Tubercular 715 547 722 .. 7 3. Brain and Nerves 602 494 652 .. 50 4. Heart, &c. 269 206 272 .. 3 5. Respiratory Organs 758 696 918 .. 160 6. Digestive Organs 227 159 210 17 .. 7. Urinary Organs 80 65 86 .. 6 8. Generative Organs 35 25 33 2 .. 9. Joints, Bones, &c. 24 16 21 3 .. 10. Skin, &c. 3 6 8 .. 5 11. Premature Birth, Low Vitality, Malformation, &c. 304 210 277 27 .. 12. Dropsy, Cancer, & Uncertain Seat 148 106 140 8 .. 13. Age 154 139 188 .. 29 14. Violence 111 88 116 .. 5 15. Not Specified. 19 50 67 .. 48 Deaths at Different Ages.—Infantile Mortality.— Calculated from the total births registered, the death-rate of infants under 1 year of age was 15.22 per cent. as compared with 14.71 in the previous year. The deaths of all children under 5 years of age amounted to 49.29 per cent. of the total deaths, as compared with 46.16 per cent. in the previous year. At the other extreme of life, i.e. at 60 years of age and upwards, occurred 19.2 per cent. of the total deaths, the proportion during the previous year being 21 per cent. 14 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 year. From 1 to 5 years. From 5 to 10 years. All under 20 years. From 20 to 40 years. From 40 to 60 years. From 60 to 80 years. 80 years & upwards. 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 1136 600 140 2021 374 500 560 138 1881 1043 627 132 1938 410 548 599 152 1882 1082 752 143 2087 428 557 634 145 1883 1189 696 134 2145 484 593 670 191 1884 1367 736 95 2341 484 623 661 157 Social position of the deceased.—The relative proportion per cent. of the mortality borne by the several classes of the inhabitants during the six years 1878—83 is compared with that of the past year in the following table:— Social Status. 1878 1879 1880 1881 1882 1883 1884. Nobility & Gentry 1.62 3.30 3.40 2.71 3.43 2.48 4.41 Professional Class 5.08 5.90 5.50 5.12 4.44 5.66 6.25 Middle Class 18.10 17.40 16.90 19.00 20.85 19.59 25.66 Industrial Class 75.20 73.40 74.20 73.17 71.28 72.27 63.68 100.0 100.0 100.0 100.00 100.00 100.00 100.00 The marked diminution in mortality among the industrial classes is shewn in this table, and forms valuable corroborative evidence of improved sanitation in. the district. 15 Inquests—Deaths ly Violence.—Uncertified Deaths.— The inquests held during the year were 178 in number, or 12 more than in the previous year, and formed 4.1 per cent of the total deaths. The whole of the deaths which formed the subjects of inquiry in the several sub-districts, with the verdicts, are enumerated in the following table:— VERDICTS. SUB-DISTRICTS. Battersea. Claphara. Putuey. Streatham. Wandsworth. Total. East. West. Deaths from Natural causes:— 18 23 11 2 3 13 70 Deaths from Violence:— Accidental:— Drowning 2 6 .. 2 .. 2 11 Run over by Train 2 .. .. .. .. 2 4 Suffocation 8 13 2 .. .. 2 27 Burning 2 .. 1 .. 1 .. 4 Fracture .. .. .. 1 1 2 4 Fall .. 6 .. .. 1 .. 9 Concussion 2 .. .. .. .. .. 2 Run over by Vehicle .. .. .. .. 1 .. 1 Other Injuries 2 4 .. .. .. 3 9 Suicidal:— Hanging 1 1 .. 2 .. 1 6 Shooting .. 1 1 .. .. .. 2 Drowning .. 3 .. .. .. 3 Poison .. .. .. .. 1 .. 1 Cut-throat .. 4 .. .. 1 1 6 Run over by Train .. 1 .. .. .. .. 1 Homicidal:— Murder .. .. 1 .. .. 2 3 Want of attention at Birth .. .. 2 .. .. .. 2 Found Dead .. .. .. 2 1 .. 3 Found Drowned .. 1 .. 6 .. 4 11 37 59 23 15 12 32 178 96 16 On reference to the table it is seen that of the total number 70 were due to natural causes, and 108 to violence. Of the latter, 62 resulted from accident, 18 from suicide, and 3 from murder. In 3 instances the cause of death remained undertermined after inquest. Uncertified Deaths.—The number of deaths in which the cause was not certified by medical testimony and in which the Coroner did not deem it necessary to hold inquests, was 72, as compared with 48 in 1883 and 96 in 1884; of these, 28 occurred in East Battersea, 19 in West Battersea, 5 in Clapham, 7 in Streatham, and 17 in Wandsworth. The importance of rendering impossible the burial of a single individual without skilled evidence as to the cause of death has been urged in former reports, and it is only necessary to repeat that without it " there cannot be that security to life which the community has a right to expect at the hands of the legislature." Sickness and Mortality amongst the Parochial Poor.—The nature, amount, and fatality of the sickness that occurred among the parochial poor in the several sub-districts, as set forth in Table V. (Appendix), forms a valuable index of the sickness occurring in the district generally. The total number of cases coming under treatment numbered 2637 as compared with 2,736 in the previous year. The proportion of deaths to cases under treatment was 3.6 per cent., as compared with 4.4 per cent. in the previous year. Meteorology.—A reference to Table VII. in Appendix will shew the general characters of the climate during the year. Taking the year as a whole its average temperature was higher, and its rainfall very much lower than the averages of a large number of previous years. In the third quarter of the year the mean 17 temperature was 3° (Fahrenheit) above the average in the corresponding quarter of 113 previous years, while the rainfall was 2.87 inches less than the mean of 70 previous years. The high temperature and comparative drought doubtless were among the chief factors in the production of the unusually great mortality from Diarrhoea in this district, though it has suffered little in this respect compared with other districts. Thus the diarrhceal mortality for the whole of London corresponded to an annual death-rate of 3.1 per 1,000, while that in the whole of this district was 1 per 1,000, and in Battersea 1.4 per 1,000. The diarrhœal death-rate in 1883 for this district was 0.69 per 1,000. Water supply.—The unusually small rainfall during the summer months of the past year caused considerable dearth of water in many parts of the country. In the Metropolis however no such result ensued, but an improved quality of water was experienced, probably owing to the fact that the water derived from surface drainage which usually finds its way into the river was nearly absent, and deep-seated springs formed the chief source of the river water. Dr. Frankland's report informs us that the Thames water supplied to London during the past year was of better average quality than in any of the previous 16 years, due largely to the longer storage which the water now undergoes before distribution. The Southwark Company by which this district is chiefly supplied still has inadequate storage capacity, thus rendering the exclusion of flood water from the reservoirs impossible. It is unsatisfactory to find as a result of this, that the water of the Southwark Company contains both greater maximum and average amounts of organic matter than any of the other waters. The Southwark Company are engaged in carrying out works which will render the admission of flood-water from the Thames 18 unnecessary; and a still more hopeful enterprise is their sinking of a well in the chalk at Streatham, the water of which is pronounced by Dr. Frankland as "of unsurpassed quality for dietetic purposes." Sanitary operations in the district.—A glance at Table VI. in the Appendix will give some conception of the amount of steady and laborious work accomplished by the Sanitary Inspectors of the various sub-districts during the past year. It by no means however gives a complete view of the work, much of which cannot be tabulated. The detailed sanitary work of the district is largely dependent on the efficiency and tact of its Sanitary Inspectors, and there is every reason to think it is being carried ont with increasing cordiality in the relations of officials and householders, and with enhanced thoroughness and detail. The number of house-inspections amounted to 27,700, and the number of notices served was 3,872, as compared with 3,342 in the previous year. 358 houses were disinfected after the occurrence of infectious disease. As disinfection has been chiefly confined to the four diseases,—Scarlet Fever, Diphtheria, Small Pox, and Fever, and there were 157 fatal cases of these diseases (implying probably 10 times as many non-fatal cases), it follows that owing to defective information only a small proportion were dealt with by the sanitary authority. In the absence of any compulsory registration of infectious diseases the remarks in the Wandsworth Local Report (page 92), on the exclusion from school of children convalescent from infectious disease, and all other children in the same house, are worthy of most careful and favourable consideration by the Board. It is curious that the regulations, the enforcement of which is urged 19 in the above local report, are likewise nominally insisted on in the code of rules issued by the London School Board to its teachers, and which hang on the walls of their school-rooms. These regulations state that "any child showing symptoms of an infectious disease, or any child coming from a house where an infectious disease exists, must be sent home at once. The medical officer of health for the district must at the same time be informed of the child's exclusion, and furnished with the name and address of the child, and the reason for its exclusion." That these regulations are almost entirely a dead letter cannot be doubted. Your Medical Officers hope that measures will be taken by the School Board Authorities for ensuring the fulfilment of these existing regulations, which at present are seldom or ever put in force. In addition to the sanitary work synopsised in Table VI., various proceedings which have not been thus tabulated have occupied the attention of your officials during the past year, such as the systematic inspection of bakehouses, cowhouses, and slaughter-houses, attendances at the Police Court, and many special inspections of vour Medical Officers. One of the most important portions of the sanitary work of the district is its Scavenging. The lack of efficiency of the contractors' work in dust-removal has repeatedly come under your consideration. An arrangement which renders it to the interests of the contractors to remove the house refuse as infrequently as possible, and in which the poorer houses are not so likely to be served as others, owing to the deficient fees to dust-men, can hardly be regarded as satisfactory. In the Poplar District pails have been substituted for the foul brick- 20 built dust-holes, and are emptied regularly three times a week. The introduction of such a plan, or better still a daily removal, would be of immense sanitary advantage to this district, and would probably be more expeditious to the dust-men, owing to the shorter time spent in carrying the galvanized iron receptacle with a cover to the dustcart. Tarpaulin covers are now commonly placed over the full dust-carts in this district, though the protection they afford is somewhat fortuitous. A fixed cover to the carts with movable lids, to be open only during the process of filling and emptying would form a much more certain protection against the dissemination of disease. The prospect of a Cholera Outbreak.—This is a question which for the last two years has much exercised the public mind. During last summer the importation of Cholera into Paris was, owing to its foul cesspool system and impure drinking water, followed by a serious epidemic. That this may be repeated during the coming summer is not at all improbable, and its introduction into London cannot then be considered unlikely. This however need cause no alarm, if only proper precautions are adopted. Much has already been done, and even if Cholera appeared it could scarcely become so widespread as in former epidemics. Certain local conditions are necessary for its existence and propagation, and these are the same as those producing Diphtheria, and more particularly summer Diarrhoea and Typhoid Fever. The prevalence of these is therefore an index of the possible inroads of Cholera. All are alike filth- diseases, due to dirt (which may be very minute in quantity but virulent in its properties), in the house or the complex contents of the dust-bin, or contamination in the drinking-water or the atmosphere. Hence the importance of general cleanliness, of early and frequent 21 removal of house-refuse from the house, of properly trapped and disconnected waste-pipes, of ventilated and well constructed drains in which no deposit occurs, of drinking water cisterns which do not supply the water-closet, but are properly covered and frequently cleansed, and of the avoidance of decomposition of whatever description. LOCAL SUMMARIES. 25 BATTERSEA. The total number of births in the whole parish during 1884 was 5,275, and the official mean population for the middle clay of that year being 125,091, a birthrate of 42 44 per thousand results. The birth-rate for the whole Metropolis according to the Registrar General was equal to 33.7 per thousand during the same year. The deaths, including those of 164 non-parishioners in the workhouse Infirmary were 2,503 in number, and on the estimated population mentioned above gave a death-rate of 20.1 per thousand, that for the Metropolis being at the rate of 20.3 per thousand. The separate reports for the East and West Divisions of the parish which follow, will demonstrate that this apparent mortality is in excess of that which actually exists, there being little doubt that the rapid increase of population, which has in the past much exceeded any estimate of the actual number of inhabitants, still continues in an accelerated rather than in a diminished ratio. If the same ratio of births to population existed in Battersea as in the rest of the Metropolis, a resident population of 156,369 in the middle of the year 1884 would have existed, which would have the result of reducing the death-rate for the year from 20.1 to 16 per thousand. 26 EAST BATTERSEA. The population of the Eastern Division of the parish of Battersea for the middle day of the year 1884, according to the mode of computation officially recognized by the RegistrarGeneral was 63,706. It is probable that this is less than the real number of persons residing in the sub-district as will be subsequently shewn when estimating the birth-rate. Births.—The number of births registered in East Battersea during the year under report was 2,621. Of these 1,360 were of males and 1,261 of females. The resulting birth-rate in the official mean population of 63,706 would be equal to 41.14 per thousand per annum, a rate which points to a larger real population residing in the sub-district than is estimated by the official method. It has been demonstrated in many previous annual reports that the real birth-rate of the subdistrict is 39 per thousand per annum, with scarcely any variation from year to year; the birth-rate of a given population being almost absolutely identical from one year to another. The estimated mean population as calculated from the known number of births and the mean annual birth-rate of 39 per thousand would be 67,205, and the census returns have always shewn calculations thus based to be almost absolutely correct. 27 STATISTICS OF MORTALITY. BATTERSEA EAST. Total Deaths from each class of Disease, &c., in the Sub-district. Sex. Age. Social Position. Population (Census) 1881 54,675 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 Y ears and upwards. Nobility and Gentry. Professional Class, Merchants. Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. Official Population in middle of 1884, 63,706 Area in acres, 947 Disease and other Causes of Death. Classes:— 1. Zymotic Small-pox 3 2 1 2 .. .. .. 2 1 .. .. .. .. .. .. 3 Measles 92 52 40 14 73 4 1 92 .. .. .. .. .. .. 10 82 Scarlatina 17 10 7 1 13 3 .. 17 .. .. .. .. .. 1 .. 16 Diphtheria 7 2 5 2 4 .. 1 7 .. .. .. .. .. 2 1 4 Croup 10 6 4 1 7 2 .. 10 .. .. .. .. .. .. .. 10 Whooping Cough 60 29 31 23 36 1 .. 60 .. .. .. .. .. 3 7 50 Fevers 25 13 12 .. 2 4 7 13 10 i 1 .. .. .. 8 1. Erysipelas 7 4 3 3 .. .. 1 4 1 1 1 .. .. .. .. 7 Metria, Childbirth 3 .. 3 .. .. .. 1 1 2 .. .. .. .. .. .. 3 Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa & Cholera 93 52 41 69 20 .. .. 89 1 .. 2 1 .. 4 13 76 Totals of Zymotic Class 317 170 147 115 155 14 11 295 15 2 4 1 .. 10 39 268 2. Tubercular 213 111 102 87 37 6 16 146 37 27 3 .. .. 4 29 180 3. Of Brain, Nerves, &c. 128 62 66 43 32 3 2 80 11 20 17 .. .. 3 24 101 4. Of the Heart, &c. 53 22 31 3 1 1 3 8 10 20 14 1 .. 4 14 35 5. Of Respiratory Organs 241 126 115 84 74 3 5 166 12 28 29 6 .. 2 29 216 6. Of Digestive Organs 22 8 14 5 2 .. 7 1 11 3 .. 1 3 3 15 7. Of Urinary Organs 15 8 7 .. 1 1 .. 2 2 5 6 .. .. 1 8 6 8. Of Organs of Generation 4 4 .. .. .. .. .. 1 2 1 .. 1 .. 2 1 9. Of Joints, Boues, &c. 4 2 2 .. .. 1 2 3 1 .. .. .. .. .. .. 4 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Premature Birth, Low Vitality, Malformation, &c. 116 67 49 116 .. .. .. 116 .. .. .. .. .. 2 13 101 12. Of Uncertain Seat 25 7 18 8 1 1 .. 10 1 9 5 .. .. .. 1 24 13. Age 19 10 9 .. .. .. .. .. .. 10 9 .. .. 7 12 14. Violence 18 12 6 5 2 1 .. 8 3 4 3 .. .. 4 1 16 15. Not Specified 9 1 8 .. 6 .. .. 16 1 •• 2 .. .. 1 3 5 Totals 1184 606 578 466 309 33 39 847 95 128 97 17 2 31 173 978 28 Mortality.—The persons whose deaths were recorded by the Registrar for East Battersea during 1884 were 606 males and 578 females. The total number was 1184. The official mean population of 63,706 for the year would demonstrate a deathrate based upon these figures of 18.58 per thousand, the mortality of the Metropolis for the year 1884 being 20.3 per thousand. It should be noted that 53 weeks' mortality is included in the year 1884, and this circumstance, which occurs every five years in order to take one whole week into computation, increases the apparent mortality rather more than 2 per cent., so that had the year only included 52 weeks the death-rate would have been equal to 18.22 per thousand. The importance of a more correct method of computing the population becomes manifest when it is stated that the estimated mean population, referred to in a preceding paragraph as 67,205, based upon the actual number or births, would shew that the real death-rate for the year was but 17.61 per thousand. Deaths in outlying Institutions.—During the year one hundred and thirty-six residents of East Battersea died in outlying Institutions, viz:— In the various Metropolitan Hospitals 76 ,, Wandsworth and Clapliam Union Intimiary 48 „ Metropolitan Asylum Board's Hospitals for Small-pox and Fever 7 „ Lunatic Asylums 5 Total 136 which is equal to a death-rate of 2.13 per thousand per annum on the official mean population. There is, per contra, no means of ascertaining the deaths which occur in the subdistrict among those who habitually reside in other parishes, but who temporarily come to the Metropolis in order to attend the various Hospitals, and dying in the sub-district, tend to unduly exalt its apparent mortality. That these cases are numerous is evident from the large proportion of such cases 29 certified by the Medical Officers of Metropolitan Medical Charities; and could they be accurately separated from the other fatal cases would probably to a great extent counterbalance the deaths of parishioners in outlying Institutions. If to the mortality registered in the sub-district, 1,184, be added 136 deaths in outlying Institutions we get a total of 1320, which would equal a death-rate of 20 per thousand; not of persons dying in the sub-district, but of deaths among its residents both in the sub-district and and elsewhere. This is according to the official, mean population, but if the estimated mean population of 67,205 be used in computing the death-rate of the whole of the residents of East Battersea, there would be deduced a death-rate of 19.6 per thousand per annum, contrasting favourably with the mortality for the Metropolis of 20.3 per thousand, a difference in favour of the sub-district of 0.7 per thousand. It is to be anticipated that as the parish becomes more densely populated, the death-rate will approximate to, if not be identical with, that of the Metropolis at large. Ages at Death.—Under one year of age there occurred 466 death or 39.2 per cent, of deaths at all ages; and from one to five years 309 other deaths, equal to 26.1 per cent, of the total mortality of 1,184. Unitedly the percentage of deaths during the infantile period of life, under five years, was 65.4, the total number of such deaths being 775. This is somewhat in excess of the average, and higher than the preceding year 1883, by 5.1 per cent, arising from the fact that during the year under review 116 deaths were registered from premature birth and low vitality against 74 in the preceding year, and that a great increase in the number of deaths occurred amongst infants from zymotic diseases. Thus, during 1883, a most exceptionally healthy vear, 152 deaths from these diseases were recorded in children J ' 30 under five years; during 1884, no less than 270 were so registered, in great part from Diarrhoea, Measles and Whooping Cough. Indeed the whole of the increased mortality of 1884 arose from the excessive infantile mortality. Nineteen persons were registered as dying from old age; seventeen of whom died at 80 years and upwards. Zymotic Diseases.—The year 1884 was characterised by an excessive zymotic mortality during the hotter and drier months of the year. The Meteorological Table in the Appendix will shew that during the summer months the mean temperature was 3°.0 Fahr. above the average, and consequently deaths from diseases attended by Diarrhœa were in excess, and outnumbered other diseases of the class. Of the 93 deaths recorded from Diarrhœa, Dysentery or Cholera, twelve, all infants under two years of age, were registered as having died from infantile) Cholera. I88418831882 1881 1880 1879 1878 Diarrhœa and Dysentery 93 5l 37 45 78 43 71 Measles 92 25 33 60 22 47 6 Whooping Cough 60 53 56 37 43 39 63 Fevers Enteric 25 14 14 17 15 13 12 Typhus 2 Scarlatina 17 17 36 20 63 44 19 Croup 10 15 3 4 4 9 12 Diphtheria 7 6 7 3 2 6 4 Erysipelas 7 1 3 6 4 4 0 Metria (Child-birth) 3 3 4 8 5 12 2 Small-Pox 3 0 0 17 1 1 5 Carbuncle 0 0 1 0 0 0 0 Total 317 185 194 217 237 218 194 Zymotic death rate per 1,000 per annum. 4.96 3.0 3.2 3.7 4.3 3.9 3.7 Excessive temperature was associated with deficient rainfall, the sum for the year being 7-33 inches below the average of 70 years. Each quarter of the year shewed abnormal dryness, 31 which in sewered districts depending upon water carriage for the removal of excreta is a matter of great moment; removal of organic matters being retarded until the interval necessary for decomposition has elapsed, which seems to be the time when the gases of such decomposition occasion some at least of the zymotic diseases, either by such products of decomposition themselves acting as zymotic poisons, or by acting as vehicles or carriers for disease germs. Another great evil was that from defective rain-fall the River Thames was in a very offensive condition, containing a very large proportion of sewage matter, a circumstance which could not fail to be injurious to the public health and tend to diarrhceal affections. Measles caused death in 92 instances. This affection was extremely prevalent in the sub-district during the whole year, and never before have so large a number of deaths been registered from this cause. Whooping Cough is the next most fatal of the Epidemic diseases and often follows Measles. The large number of 60 deaths were recorded from this disease. It may be remembered of the two latter diseases that ordinary sanitary measures have but little influence in their prevention, that they arise from direct infection, and that the fatal cases indicate an enormous number of attacks, as the percentage of mortality is but small. Enteric Fever caused death in twenty-three instances and a severe type of simple continued Fever was fatal in two cases. There were no fatal cases of Typhus. Scarlatina is credited with seventeen deaths, the same number as in the preceding year, and very much below the average number of fatal cases. Croup caused death in ten instances and Diphtheria in seven. Many cases registered as from Croup are probably really cases of Diphtheria of the air passages. The numbers are about the normal. 32 Erysipelas was returned as the cause of death in seven cases, and the diseases of child-birth three. These also are not above the average. Three deaths from Small-pox are recorded as having taken place in East Eattersea, but four other deaths took place in the Hospitals of the Metropolitan Asylums Board of persons removed from the sub-district. Sixteen cases of persons suffering from this disease came under care and all were, where practicable, at once removed by the Metropolitan Asylums Board's Ambulances. An immense improvement in the method of removing the sick suffering from Small-pox or Fever has resulted from that Board having undertaken the carriage of such cases, which are generally removed within a couple of hours after notice in a properly constructed ambulance, with which is sent a nurse and proper nourishment and stimulants for the journey. I have also to add that those whom I have sent to the Hospitals of the Metropolitan Asylums Board have expressed themselves in the highest terms of the treatment they have received while inmates, as regards medical attendance, nursing, food, lodging and clothing—with one notable exception—that of a man who went very unwillingly and then only when compelled to do so by his superior officer; and who was evidently pre-determined to find fault with every thing. All others speak of the treatment in these Hospitals in the highest terms and with much gratitude. Other Diseases.— Diseases of the Respiratory Organs caused death in 241 instances during 1884 compared with 248 in 1883; diseases of the Tubercular class, viz:—Pulmonary Consumption, Atrophy, and Hydrocephalus, 213, against 175; Brain diseases, 128 against 119; Heart disease, 53, while in the former year 44 deaths so arose, and from Premature Birth, Low Vitality, Malformation, &c., 116 deaths were registered in 1884 against 74 in 1883. 33 Grouping together all these principal non-zymotic causes of mortality there is shewn a total of 751 dsaths in the year under report, while in the preceding year but 650 fatal cases were so recorded. This increase is probably from climatic conditions as well as the result of a substantial increase of the population. The fatality of the other diseases of the non-zymotic class was about the average as to numbers. Deaths not Certified.—During the year 24 deaths took place in which no medical certificate of the cause was forthcoming. The whole of these cases, with one exception, were submitted to the Coroner, who decided that being presumably from natural causes no inquest was necessary. The exceptional case referred to was that of a newly-born infant, surviving birth 14 hours and registered as "attended by Midwife." This is a great improvement in the condition of deathregistration, as but a very few years ago a large proportion of persons were buried without either medical certificate or any investigation by competant authority into tae cause of death. Inquests. —Thirty-seven inquests were held in the subdistrict during the year, the verdicts biing as follows: — From Natural causes 18 „ Accidental causes— Asphyxia (infants overlaid 4) 8 Scald or Burn 2 Drowned 2 Killed on Kail way 2 Concussion of Brain, &c. 2 Erysipelas following injury 1 Alcoholic Poisoning 1 — 18 Homicidal— Suicide by Hanging 1 37 34 In addition to which 23 cases were submitted to the Coroner as mentioned in the preceding paragraph, making a total of 60 cases investigated by him during the year in East Battersea. Social Position.—The relative proportions of deceased persons in the several grades of the social scale were as follows:— No. per cent. Nobility and Gentry 2 = -2 Professional Class 31 = 2.6 Middle and Trading Class 173 = 14.6 Industrial and Labouring Class 978 = 82.6 Totals 1184 100.0 The most noticeable feature in the above table is the steady diminution year by year of the few persons who may be classed among the nobility and gentry. Against this is a rapid increase in both the professional and trading classes, the result of the conversion of the sub-district from a purely agricultural, to a manufacturing and commercial suburb. Vaccination.—The register of public vaccination shews that tiie following successful operations were performed at the appointed station by the Public Vaccinator:— Primary Vaccinations 1,309 Re-vaccinations 134 Total 1,443 being a slight increase on the numbers of the preceding year. About one half of the children born in the sub-district were va cinated at the public station, a diminution compared with for.ner years when the majority of such infants were presented there for vaccination. Bakehouses.—1 here are 42 bakehouses in the sub-district, and they have each been inspected twice during the year. Three notices to cleanse and white-wash were carried out, 35 but an order to remove the water-closet lrom immediate connexion with one bakehouse was resisted. Upon taking the case before the Magistrate I obtained an order to remove, upon w hich the work was at once carried out. I am therefore able to report that the whole of the bakehouses in Eastern Battersea are in a proper and cleanly condition. Cow-houses.—There are now but three cow-houses in the sub-district, and as it is most undesirable that milch cows should be kept in towns it is to be hoped that all milk will eventually be brought from the country. Slaughter-houses.—There are at the present time four licensed slaughter-houses in East Battersea. There have been no complaints during the year as to the manner in which they have been conducted. It would however be much better if public abattoirs were built in each parish. Sanitary Operations.—A large amount of sanitary work, the result chiefly of defects discovered by domiciliary inspection, has been effected during the past year. The very exhaustive house-to-house inspection made by the additional inspectors appointed during 1883 had the good result of remedying most of the grosser nuisances,— and year by year fewer will be left to be detected by the Inspectors of Nuisances. The plan of appointing an Assistant Sanitary Inspector to each Ward under the Superintendence of the Surveyor and myself and controlled more immediately by the Chief Inspector of Nuisances, Mr. Richards, will ensure more frequent and regular inspection of every house in the subdistrict; without which, defects of great moment to the public may remain undiscovered and consequently unremedied for a considerable period. Without such increase in the sanitary staff it would have been impossible to carry out the amount of work exhibited in the sub-joined table, in considering which there should be taken into consideration the fact that for eight months of the year under consideration there was but one assistant inspector for the sub-district. 36 Abstract of Sanitary "Work carried out in Eastern Battersea, Luring the year ending Decewler 31 st, 1884. No. of houses inspected 5281 „ 1st Notices served 644 „ 2nd Notices served 24 ,, houses disinfected and -where necessary cleansed after small-pox 19 ,, houses disinfected and where necessary cleansed after various kinds of Fever 68 Drains unstopped and cleansed 145 „ tiapped and repaired 252 No. of houses -where separate drainage has been enforced 20 Dilapidated closets repaired 35 Foul and offensive closets cleansed 105 New cisterns provided or cisterns repaired 181 Covers to cisterns provided 88 Dirty cisterns cleansed 76 Water supply added to houses 18 Dirty and dilapidated houses cleansed and repaired 159 Defective roofs repaired 114 Overcrowding abated 11 Orders of the Board obtained 35 Summonses and Magisterial orders obtained 6 Dust-bins provided or repaired 141 Accumulations of manure removed 16 Pig nuisance removed 2 It will be perceived that the large number of 5,281 house were inspected during the year; this however is somewhat less than halt the number of the houses in the sub-district. To ensure the inspection of every house at least once in the year is the minimum which should be permitted to exist, and this can now be effectively carried out by the two assistant inspectors. It was found necessary to serve 644 notices to amend sanitary defects in the houses and premises inspected. In many cases the notices specified more than one such defect. 37 The readiners with which the Foard's requirements are met is conclusively shewn by the fact that in but 24 instances was it necessary to serve second notices preparatory to enforcing by magisterial aid the execution of necessary works. Ultimately six cases were taken into Court and peremptory orders obtained in every instance. A large amount of disinfection after Small-pox, Fever and other Zymotic diseases was performed under my instructions during the year, with the result that in no case did disease recur; adding to the confidence I have always felt in the method of disinfection adopted in the sub-district, namely the production of sulphurous acid gas by burning sulphur in the apartment after it has been properly prepared by stopping up all crevices and apertures, thus making it air-tight as possible, and leaving in the room all bedding and clothing in use during the continuance of the zymotic disease. In no case has either an apartment, furniture, or clothing so treated, been the means of spreading contagious disease subsequently. It will be observed that a large number of defects were found to exist in house drains, which have in too many cases been detected only after the occurrence of zymotic disease, and which but for defects of this character would probably be much diminished, as infectious diseases such as Enteric Fever and Diphtheria are generally contracted from defective drains permitting the escape of sewage gas, or from impure water. With reference to the latter source of danger it is shewn that many cisterns have been repaired, covered or cleansed. It has been the practice to insist on the closing of wells when the water therefrom has been proved by analysis to contain an excessive amount of organic matter, the use of water derived from wells polluted by having some connexion with cesspools constituting a frequent cause of disease and loss of life in former years, nearly all of which is now averted by the adoption of the modern system of water supply and more perfect drainage. 38 A large number of dust-bins have been provided or put into a proper condition during the year. There can be no doubt that in the near future a great change in the method of collecting household refuse must take place. More methodical removal will be urgently insisted upon and that can only be properly carried out by the Board's own staff, experience having shewn that the contract system fails just when frequent removal is most necessary, during the hotter months of the year, when ash production is at its minimum, rendering it unprofitable to collect so frequently as during the winter, when more ashes are to be obtained. In the summer a greater quantity of vegetable and other organic refuse is thrown into the common receptacle, the dust-in, with the result of more offensive and active decomposition of its contents. The whole subject of the removal of house, stable, trade and other refuse constitutes a problem which must be taken into active consideration by the various local authorities of the Metropolis before long. The possible advent of Cholera, in view of the severe outbreak in Southern Europe was the cause of much sanitary activity during the later months of 1884; and although there is substantial reason for hoping that we shall escape a visitation of this fatal disease in 1885, the year in which in obedience to the laws of its progression in former epidemics it might be expected, it behoves all responsible for the public health to adopt every precaution, so that we may not be found unprepared should an outbreak occur this year, recollecting that all measures of a preventive sanitary nature are valuable as diminishing the prevalence of other epidemic diseases. In conclusion I have once more to thank the Members of the Board and its Committees for the continued support and assistance in carrying out my duties in the sub-district which they have been pleased to accord me, and without which it would have been impossible to discharge 39 those duties with satisfaction to myself or advantage to the inhabitants of this large and densely populated district. Of Mr. Pilditch, the Surveyor for Battersea, it is again my privilege to say that his uniform courtesy and unvarying desire to afford me every possible aid, merit expressions of gratitude. Mr. Richards, the Chief Inspector of Nuisances, has, as heretofore, exhibited untiring devotion to the duties of his office, and high terms of praise can be appropriately adopted in speaking of his work during the year. W. H. KEMPSTER, M.D., Medical Officer of Health for Eatt Battersea 40 WEST BATTERSEA. The year under report contains the record of 53 weeks. It has been a truly remarkable one from the following circumstances. The death rate for the Metropolis is the lowest which has ever been recorded, pointing out clearty the better conditions under which we live. The marriage rate was the lowest on record, and as a natural sequence so was the birth-rate, a condition perhaps not altogether to be deplored. But the latter does not apply to this district, for in the place of being the lowest it is the highest it has been my lot to record, viz:— 43.3 per 1,000, being 8 per thousand more than that of the census year when the population was accurately known, and which tends to show that we have a much larger population than that for which we take credit. It will also be evident that the death-rate from the same cause will be proportionately increased, and which instead of baing 18.6 par 1,000, would be reduced to 14.7, if we take the birth-rate as a basis. 41 The health of the district has been fully up to the average. The expected visitation of Cholera happily was not realized, though a large amount of Diarrhoea prevailed during the summer months. Small Pox showed unmistakable signs of becoming epidemic, but thanks to the prompt measures taken for the removal of patients so afflicted (the ambulances being as su ggested three years ago kept at a central office it is only necessary to telegraph, and the patient is generally removed within a few hours), the sanitary measures pursued, and above all re-vaccination; up to the present we have been able to check considerably this disease. Of all the cases which have come under notice, there is scarcely one below adult age, and when it is not so, they are of such a modified character as to excite not the least alarm for the patient's safety. So much has been said in reference to vaccination and re-vaccination that I need not here repeat its doctrines, but simply remark that the more one sees of this terrible disease the more I am convinced of the complete protective power of vaccination, and I strongly support the efforts of the Board to bring this important fact before the minds of all the inhabitants. If anything could be necessary to further impress upon the people the benefits conferred by this operation the following letter taken from the Standard of this year will supply it. To the Editor of the Standard. Sir,—Referring to your article in The Evening Standard of this date concerning Mr. Russell's answer to Mr. Hopwod's interpellation on this subject, will you allow me through the medium of your columns, to express my regret that Mr. Russell was apparently ignorant of the overwhelming evidence on this subject which the annals of this, the oldest, and for more than a century, the sole hospital for Small Pox in London, presents. 42 I have records now of nearly 50 years, during which no nurse, servant, or other employe of this hospital has ever contracted Small Pox, even in a modified form. They are re-vaccinated when they enter the service of the hospital, and they consequently never take the disease. The only exception to this rule was that of a gardener who was temporarily engaged in 1881. This man refused to be vaccinated, took the disease, and died. That these people are not protected by a previous attack of Small Pox is shown by the fact that when engaged only 20 to 25 per cent, (the per-centage varying somewhat in each year) have previously suffered from the disease. Such facts as these must, I think, carry conviction with them to all unprejudiced minds, and do not appear to me to be open to augument. To those who, like myself, have the every day experience of a Small Pox Hospital before them, the fact that any body of sane persons can in the present day doubt the benefit conferred by efficient vaccination and re-vaccination, is the most astounding reflection of all. Yours faithfully, HERBERT GOUDE, F.R.C.S. Edin. Resident Surgeon, Small Pox and Vaccination Hospital, Highgate Hill, Upper Holloway, N., April 1st. All deaths which have occurred in Institutions outside the district, that is the Metropolitan Hospitals, including those of the Asylums Board, are taken into account in calculating the death-rate, they are this year 66 in number, and add a little over 1 per 1,000 to the death rate. This should be remembered when comparing the rates for the past ten years, 43 as it is only during the last two years that these outside deaths have been received and taken into the calculations,consequently the latter two bear unfavorable comparison with the former. House to house inspection has been vigorously carried out during the year, though owing to the temporary Inspectors being discontinuedfor some months, the numbers are fewer than those of the previous year. Sanitary books with the headings considerably increased so as to embrace every detect, whether of drains, water, dust-bins, dirty and unclean rooms, overcrowding, cubical space, &c. have been instituted and made as perfect as possible. This house inspection is one of the most important sanitary operations carried out, having for its object the placing of houses and their surroundings in as cleanly and sanitary condition as possible. Further information on sanitary matters will be found at the end of the report. Population.—The population estimated by the Registrar General's method for the middle of the year would be 61,385, but if we take the birth rate of the census year as a basis of calculation which is more reliable, we shall find the numbers are much greater; for instance, the rate of the census year was 35 per 1,000, it is now 43, the difference being 8, and which would give upwards of 75,000 as the approximate number of persons now residing in this district. Mortality.—The total number of deaths returned by the Registrar as having taken place in this sub-district was 1,319, of which 682 were males and 637 iemales. In 1883 1,341 were returned, there is therefore a decrease of 22 on that year. In addition to the above, 66 took place in institutions outside the district, making a total of 1,385 persons who died connected with this division of the parish. 44 Of the 1,319, 283 occurred in public institutions, viz:—260 in the Infirmary and 14 in the Bolingbroke Hospital; these are 19 below those of the previous year. Of the deaths which took place in the Infirmary 55 belonged to West Battersea, the remainder belonging to other sections of the district. Deducting the 283 deaths in Public Institutions 1,036 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 Quarter 354. Second Quarter.288 Third Quarter. 340 Fourth Quarter. 337 The deaths of 47 illegitimate children were registered, the ages being specified by minutes, hours, days, weeks, and months, but six having reached the age of one year and upwards. Total deaths from all causes including all deaths in the Infirmary in the respective years were :— 1875 1876 1877 1878 1879 1880 1881 1882 1883 1884 856 854 820 908 1002 1010 1195 1222 1041 1319 lhe deaths in the Infirmary were 269—males 152, females 1.7. The death-rates per 1,000, including Infirmary deaths belonging to this sub-district and out-lying Institutions:— 1875 1876 1877 1878 1879 1880 1880 1882 1883 1884 20.2 19.5 17.1 18.5 20.0 16.8 19.0 18.0 18.6 18.8 45 The deaths during the last year not including those occurring in its Institutions, nor those occurring in out-lying Institutions, numbered 1036; these give a death-rate of 16.9 per 1,000. The death-rate for the Metropolis was 20.3 per 1,000, the lowest on record. Birth-rate.—The number of births registered were 2,654, of which 1,355 were males and 1,299 females, being a difference of 56 in favor of the males. The rate is 43.3 per 1,000, being 8 per 1,000 more than that of the census year, at the same time the same increase of population as in the preceding decennial period has been allowed. lhs return for each quarter was as follows:— First Quarter. 641 Second Quarter. 657 Third Quarter. 654 Fourth Quarter. 702 Natural Increase.—The above number of births are 1,563 in excess of the deaths, and constitute the year's natural increase, more than double those of the deaths, an excess more than ever before known. The following table shows the cause of all deaths, classified according to age, sex, and social position, which have taken place in this sub-district during the year:— 46 STATISTICS OF MORTALITY. BATTTERSEA WEST. Population (Census) 1881 52,587 Official Population in middle of 1884 61,385 Area in Acres, 1,396 DISEASES And other Causes of Death Total Deaths from each Class of Disease, &c„ in the Sub-District, Sex. Age. Social Position. Males, Females, Under,! year. From 1 to 5 years, From 5 to 10 years. All under 20 years. At 20 and under 40 years of age, At 40 and under 60 years of age, At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry, Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes, Classes:— 1. Zymotic Small Pox 2 1 1 .. .. .. .. 1 1 .. .. .. .. 1 1 Measles 42 25 17 10 32 .. 42 .. .. .. .. .. .. 5 37 Scarlatina 14 6 8 2 9 1 13 1 .. .. .. .. .. 3 11 Diphtheria 11 5 6 3 7 1 11 .. .. .. .. .. .. 1 10 Whooping Cough . 46 22 24 28 18 .. 46 .. .. .. .. .. .. 7 39 Typhus anc other Fever 21 9 12 .. .. 4 9 8 2 2 .. 1 .. 3 17 Diarrhoea & Choleraic Disease 82 45 ?7 71 7 .. 78 1 1 1 1 2 .. 4 76 Erysipelas 8 6 2 1 .. .. 1 .. 2 5 .. .. .. .. 8 Metria, Childbirth 11 .. 11 .. .. .. 1 9 1 .. .. .. .. 2 9 Carbuncle. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup 14 9 5 1 10 3 14 .. .. .. .. .. .. 4 10 Quinsy .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• Totals of Zymotic Class 251 128 123 116 83 9 215 20 7 8 i 3 .. 30 218 2. Tubercular 26S 148 118 90 29 2 136 76 48 6 .. 1 2 23 240 3. Of Brain & Nerves 170 76 94 49 23 7 83 11 30 42 4 2 4 23 141 4. Of the Heart 95 40 55 3 2 3 15 12 28 33 2 4 .. 12 79 5. Of Respiratory Or gans 218 139 109 67 42 4 114 30 37 58 9 5 2 42 199 6. Digestive Organs 6? 40 23 14 .. 2 17 5 16 23 2 6 .. 12 45 7. Urinary Organs 19 12 7 .. .. 1 1 2 10 6 .. 1 .. 4 14 8. Of Organs of Generation 12 2 10 .. .. .. 2 2 3 5 .. 1 .. .. 11 9. Of Joints, Bones, &c 12 4 8 4 1 .. 7 3 1 1 .. .. .. 1 11 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Premature Birth, Low Vitality, Malformation, &c. 33 18 15 33 .. .. .. .. .. .. .. .. .. 2 31 12. Of Uncertain Seat. 66 30 36 14 .. .. 15 9 14 26 2 1 1 9 65 13. Age 45 2l 24 .. .. .. .. .. 1 26 18 2 .. 3 40 14. Violence 39 24 15 13 6 .. 25 4 7 2 .. .. .. 1 38 15. Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1319 682 637 403 186 28 669 174 202 241 38 26 9 162 1122 * This table includes 269 deaths in the Infirmary of the Union, and 14 in other public Institutions, leaving 1,036 as the correct number of deaths which took place in this oub-door district. 47 Zymotic Mortality.—The deaths from this class of disease were 251—128 being males and 123 females, and are 39 in excess of those in the previous year. The greatest fatality was from Diarrhoea, Whooping Cough and Measles, which contributed 152 of the total. As compared with last year there is an increase in Diarrhoea and also in Scarlet Fever. 6 were returned as Infantile Cholera. Diarrhoea was extensively prevalent in the summer months owing to the high temperature which prevailed. From Fevers other than Scarlet and Measles there were 21 deaths, classified as follows :— Typhoid or Enteric 17 Typhus 1 Puerperal 3—21 The case of Typhus was that of a female employed managing a business at Putney. Of the total number, 16 were under 1, 83 from 1 to 5 years of age, and but 9 from 5 to 20; it will thus be seen that the period of life most susceptible to this class of disease is up to 5 years of age. Zymotic Diseases.—The following table contrasts all deaths from Zymotic causes during the past 10 years. 1875 1876 1877 1878 1879 1880 1881 1882 1883 1884 Small Pox 0 3 13 2 2 0 4 1 0 2 Measles 11 35 8 34 43 8 50 30 52 42 Scarlatina 48 20 8 4 55 30 25 35 26 14 Diphtheria 7 5 2 3 7 3 9 4 2 11 Quinsy 0 0 0 0 0 0 0 0 0 0 Croup 3 6 5 10 8 1 3 12 8 14 Whooping Cough 20 32 18 36 11 23 31 47 46 46 Typhus, &c Erysipelas 14 19 25 15 27 10 10 14 13 21 9 0 3 4 2 3 7 9 5 8 Metria 6 5 3 1 2 7 6 3 2 11 Carbuncle 0 0 0 0 0 0 0 0 0 0 Influenza 0 0 0 0 0 0 0 0 0 0 Diarrhoea and Cholera 35 43 22 41 17 61 53 39 64 82 Totals 155 168 107 157 174 146 198 194 218 251 48 The death-rate from this class of diseases was 4 per 1,000 of the population. Other causes of death than Zymotic.—These diseases collectively show a decrease on those of the previous year of 55—1,068 being returned against 1,123, the principal of which were:—diseases of the Respiratory Organs, 248; Bronchitis, 133; pneumonia, 45; and other diseases, 70. These are collectively 70 below those of the previous year, owing to the mild season which prevailed the last few months of the year. From diseases of the Brain and Nerves 170 were returned, Heart, 95; Digestive Organs, 63; Age, 45; Premature Birth and Low Vitality, 33; Violence, 33; Cancer, 7; Syphilis, 10, &c. Disease of the Respiratory Organs, Old Age, and Cancer show a decrease, whilst those of the Nervous system, Heart, Violence, and Syphilis an increase. From the Tubercular Class, 266 were returned, viz:— Phthisis, 145; Atrophy, 93; Scrofula, 24; and Hydrocephalus, 4. Of the Phthisical deaths, 20 were under 20, 76 between 20 and 40, and 48 between 40 and 60 years of age. The deaths from Old Age were 45 against 64 of last year, the eldest being—female 90, males 92 and 97 respectively; the latter was said to be over 100 years, and certainly had that appearance, but no reliable information of the fact could be obtained. Of the opposite extreme we find the duration of life was by minutes in 2 instances, hours in 11, and 43 by days. The deaths from Violence were in every case the subject of inquests. Of the 1,068 deaths, 554 were males and 514 females; 409 were under 20 years, and the remainder from 20 upwards. The following table contrasts all deaths from non-zymotic causes during the past 10 years. 49  1875 1876 1877 1878 1879 1880 1881 1882 1883 1884 Tubercular, including Phthisis 148 149 172 143 163 196 210 198 255 266 Of Brain,Nerves, &c 130 119 148 137 136 117 147 173 168 170 Of the Heart. &c. 37 49 55 53 56 72 94 83 85 95 Of the Bespiratory Organs, including Phthisis 197 160 124 201 260 215 266 272 318 248 Of Digestive Organs 27 19 37 27 27 47 59 59 68 63 Of Urinary Organs 10 13 14 10 20 15 26 21 32 19 Of Organs of Generation 7 8 8 3 9 9 14 14 11 12 Of Joints, Bones, &c 8 4 1 2 2 3 15 12 19 12 Of Cancer 2 23 22 23 14 22 21 25 33 17 Premature Birth, Low Vitality, Malformation, &c 37 30 30 31 36 70 37 78 30 33 OfUncertain Seat 39 37 25 29 17 36 27 27 13 39 Age 39 53 7 58 57 35 31 37 64 45 Violence 15 18 23 28 13 23 40 30 20 39 Syphilis 6 4 7 11 16 4 10 6 7 10 Totals. 702 686 713 751 828 864 997 1028 1123 1068 Inquests.—Enquiries were held on the bodies of 37 malts and 22 females, in all 59, being an increase on those of last year of 23. The verdicts were as follows:— From Natural Causes 23 ,, Accidental 28 Suicides 7 Found Drowned 1 59 Of the accidental causes 8 were those of Infants suffocated in bed, 5 of boys drowned whilst bathing, 6 from falls, and 5 50 from asphyxia, one of which was by carbolic acid, and another whilst attempting to swallow an oyster which became impacted in the glottis. The suicides were respectively— 4 Cut-throats 1 By Shooting 1 By Hanging 1 On the Railway. In each case temporary insanity was added to the verdict. In addition to the above, 19 cases of sudden death were submitted to the Coroner who did not deem an inquest necessary. They were those of young children or persons the subjects of chronic disease. The Infants suffocated in bed with their parents are 6 in excess of those of the previous year and occurred on the following dates :— December 27th, 1883, Thursday—Boxing Night. February 3rd, 1884, Sunday Night. „ 9th, „ Saturday Night. „ 23rd, „ Saturday Night. October 13th, „ Monday Morning. „ 14th, „ Tuesday Night. „ 26th, „ Sunday „ December 27th, ,, Saturday—Boxing Night. Deaths not Certified.—Under this head the Registrar General places 22, but it must be understood as stated above that 19 were submitted to the Coroner, who after due enquiry issued his order for burial. Three were ordered to be registered by the Registrar General, so that none were consigned to the grave without official enquiry. There was but one person who died attended by an unqualified person. 51 Social Position.—The per-centage of deaths, in relation to social position was as follows:— Nobility and Gentry 26 = 1.95 Professional 9 = .67 Middle and Trading Class 162 = 12.28 Labouring 1122 = 85.1 1319 100.00 Disease and Mortality amongst the Union Poor.—The number of cases which came under treatment was 514—282 being males and 232 females; these are 106 above those of the previous year; indeed there has been a steady increase during the past three years in those seeking parochial medical relief. The increase is principally in general diseases and Small Pox, the latter being 20 against 1. Of the above cases 20 died, giving a death-rate of 3.8 per cent. Sanitary Matters.—Owing to the discontinuance of the extra Inspector during the first eight months of the year the number of inspections particularly as regards houses has not been so great as in the previous; still the number of defects found were nearly as many; this is owing to the new registers having so many extra colums which causes enquiries to be made concerning matters previously un-noticed. It is gratifying to observe the number of defects which are remedied merely by requisition. Out of 1,016 first notices served, in only 45 was it found necessary to serve a second, and in only 8 cases were summonses issued to enforce compliance. The importance of house to house visitation having been so fully recognised, an Inspector is now appointed to each Ward, so that by his daily work we hope to keep the district under efficient observation. The means used for disinfection are the same as herefore, and are still found most satisfactory, as it is rarely indeed a second case occurs unless the individual was infected 52 previous to its usage. The cost for disinfection in each case is about 2/3 per room. The Police Court was attended and evidence given in reference to putrid rabbits seized in Falcon Lane, conviction being obtained and fine imposed. Also in reference to a quantity of pork taken from a cart being driven fro n a slaughter-house in York Roa 1, the meat was ordered to be destroyed, and it was only by the technical objection raised that it was not in the slaughter-house when Seized, that the owner escaped i nprisonment. Too much praise cannot be accorded to Mr. Richards for the manner he acted in this case and the firmness exhibited under most trying circumstances. I may also state I have had frequent occasions to require the assistance of Mr. Richards at most unseasonable hours and also on Sundays, and that assistance is always given most willingly and cheerfully. Cow and Slaughter-houses were all inspected and the licences renewed, with the exception of Mr. Curtis at Broomwood, who has hince desisted from cow-keeping at that place. Bakehouses are under periodical suspervision, and their condition bears very favorable contrasts to what it was two years ago ; in fact they may be said to be in a first class sanitary condition. Frequent complaints were made of the offensive effluvia emanating from the sewer in Lombard Road; the temperature of such sewer was found to-abnormally high, as much as 120° F., and the cause of such heat was proved to be very hot water discharged into it from Messrs. Whiffins Chemical Factory; frequent] observations were made, the results of which will be in the recollection of the Board, as a consequence firm action was taken, the effluent hot water was cooled and no complaints have since been made, a terrible nuisance being got rid of. The same course was taken in reference to other factories. 53 Abstract of Sanitary work carried out in Western Battersea during the year ending December 31st, 1884. Number of houses inspected 7215 ,, first notices served 1016 ,, second notices served 45 ,, houses disinfected and where necessary cleansed after Small-Pox 31 ,, houses disinfected and where necessary cleansed after various kinds of Fever 67 Drains unstopped and cleansed 213 ,, trapped and repaired 288 Combined drainage 5 Dilapidated closets repaired 18 Foul and offensive closets cleansed 26 Defective apparatus to water closets repaired and water laid on 142 Covers to cisterns provided 146 Dirty cisterns cleansed and repaired 33 "Water supply added to houses 16 Dilapidated and Dirty houses cleansed and repaired 157 Overcrowding abated 4 Urinals cleansed 4 Orders of the Board obtained 23 Summonses 8 Cesspools abolished 1 Dust-bins provided 210 Accumulation of manure removed 3 Pig nuisances removed 13 Leaky and dilapidated roofs repaired 60 Articles destroyed as unfit for human food—Fruit, 9 pecks; Crabs, 150 ; Rabbits, 20 ; Pork, 358 lbs., Beef, 80 lbs. JOSEPH OAKMAN, Medical Ojficer of Ifealth for West Battersea. 54 CLAPHAM. The report which I have the honour to present for the first time, records a sanitary condition on which the Clapham Committee of the Wandsworth Board of Works may be cordially congratulated. The low rates ot general mortality and of mortality from infectious diseases are very encouraging, and the excellent and thorough sanitary work which is being executed by Mr. Southam and his assistants, gives us every reason for believing that this improvement, already striking, will be continued. Population.—Assuming the rate of increase to be the same as in the decade previous to the last census, the population ot this sub-district for 1884 was 39,632. As only three years have elapsed since the census, probably this estimate is a near approximation to the truth. Births and Birth-rate.—The number of births registered was 1,123, of which 596 were males and 527 females. The annual birth-rate was 28.32 per 1,000 of the estimated population, being nearly the same as in the three previous years, and considerably less than that for the whole of London, which was 33.7 per 1,000. Deaths and Death-rate.—During the year 1884, 543 deaths were registered in the sub-district, 263 of males and 280 of females. These represent an annual death-rate of 13.7 per 1,000 of the estimated population, the lowest hitherto known in Clapham with a solitary exception (see table). The death rate for the whole of London was 20.34 per 1,000, and that of 28 large towns was 21.6 for the same period. The excess of births over deaths or natural increase in the population was 580, giving a rate of 14.6 per 1,000. 55 YEARS. Births. Birth-rate Number of Deaths from all Classes. Death-rate Rate of Natural Increase. 1875 965 30.6 548 18.2 13.'2 1876 1095 34.3 545 17.7 15.8 1877 1029 32.4 467 14.8 18.5 1878 1019 34.2 580 18.1 15.9 1879 1125 34.1 561 17.0 17.0 1880 1082 29.7 544 14.9 15.1 1881 1059 28.9 499 13.5 15.3 1882 1081 28.8 544 14.5 14.3 1883 1085 28.25 580 15.1 13.1 1884 1123 28.32 543 13.7 14.6 Deaths in Out-lying Institutions..— lhe deaths just enumerated do not include those of inhabitants of this sub-district who have died in out-lying institutions. In the following table however, these additional deaths (102 in number) are arranged so as to shew the causes of death, age, and sex of patients, and character of the Institution in which they died. DISEASE. Sex. Age. Institutions. Total Males Females Under 1. 1 to 60 60 & upw'ds Union Infirmary. Infection Hospital. Genrel Hospital. Diphtheria 5 2 3 1 4 .. .. .. 5 Scarlet Eever 1 1 .. .. 1 .. .. 1 .. Enteric Fever 1 1 .. .. 1 .. .. .. 1 Measles 1 .. 1 1 .. .. 1 Small Pox 1 1 .. .. 1 .. .. 1 .. Whooping Cough 1 1 .. 1 .. .. 1 .. Tubercular Diseases 14 8 6 .. 13 1 6 .. 8 Lung Diseases 16 13 3 1 6 9 11 .. 5 Circulatory Diseases 7 3 4 .. 1 6 5 .. 2 Nervous Diseases 12 7 5 .. 9 3 8 .. 4 Other Diseases 40 19 21 5 21 14 20 .. 20 Violence 3 1 2 1 2 .. .. 3 102 57 45 10 59 33 52 2 48 56 It will be seen that 62 of the 102 deaths occurred in the Wandsworth and Clapham Union Infirmary, and 50 in the various general and special hospitals of the metropolis. If these 102 deaths be added to those occurring in Clapham, the death-rate becomes 16.27 per 1,000, a figure which still speaks well for the healthiness of Clapham as a residential neighbourhood. This becomes even more apparent when we compare the density of population and death-rate of the present year with those of ten years ago. It is a well established fact that the death-rate varies directly with the density of the population, not because of any necessary association between the two (as shewn by the experience of Peabody Buildings), but because a denser population means the presence of a class of persons who are less likely to live in accordance with the laws of health, and who from overcrowding and neglect of ordinary precautions are more prone to infectious, tubercular and other diseases. In Clapham we find however that in 1874 there were 22 persons to every acre, and the death-rate was 17.9, while in 1884 there were 32 persons to every acre, and the death-rate was only 13.7. Death-rate of special farts of Clapham.—The mortality of Clapham as a whole was compared with three selected portions of the parish, in which the artizan and labouring classes are almost exclusively represented. The population of these parts of the parish was ascertained from the books kept by the Sanitary Inspectors of the results of inspections during the past year. (1) The first neighbourhood selected is bounded by the New Road and London Chatham and Dover line on two sides, and the Heath wall sewer and Wandsworth Road on the two opposite sides. Its population was 1864, the number of houses in it 327, and its death-rate 20.9. 57 (2) The second neighbourhood is bounded by Queen's Road and the London Chatham and Dover Railway on two sides, and Heath Road and Wandsworth Road on the two opposite sides. Its population was 5,128, the number of houses in it 770, and the death.rate 17.9. (3) The third neighbourhood, including White Square and the surrounding parts, was bounded by Pleasant Place and Crescent Road on two sides, and Park Crescent, Nelson Road, and White Square on the two opposite sides. Its population was 1,576, the number of houses in it 301, and the death.rate 17.7. The mortality given in these three selected parts of the parish does not include the deaths occurring in out.lying Institutions. Including these, the death.rate is still except in the first.named only about equal to the general death rate or the whole of London, though considerably above that for the whole of Clapham. The larger mortality in these three neighbourhoods, is chiefly explicable by the high mortality among children under 5 years. In (1) these formed 60 per cent. of the total deaths; in (2) 73 per cent.; in (3) 57.5 per cent., as compared with 47.3 per cent. for the whole of Clapham, and 49.3 lor the whole district. Deaths occurring in Clapham.—The following table gives a summary of all the deaths registered as occurring in this sub.district during the past year, classified according to cause, sex, and social position, and a more detailed list of the deaths from zymotic diseases. 58 STATISTICS OF MORTALITY. CLAPHAM. Total Deaths from each Class of Disease, &o., in the sub.disstict. Sex. Age. Social Position. Population (Census) 1881 36,380 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. Official Population in middle of 1884 39,632 Area in Acres, 1233. DISEASES. and other causes of Death. Classes:— I. Zymotic Small Pox 2 1 1 .. .. .. 2 2 .. .. .. .. .. .. 1 1 Measles 33 20 13 9 24 .. .. 33 .. .. .. .. .. .. 16 17 Scarlet fever 3 3 .. .. 2 1 .. 3 .. .. .. .. .. 1 2 .. Diphtheria 8 2 6 .. 3 4 1 8 .. .. .. .. .. 2 5 1 Croup 5 4 1 1 4 .. .. 5 .. .. .. .. .. 1 2 2 Whooping Cough 15 6 9 10 5 .. .. 15 .. .. .. .. .. .. 8 Typhoid & other Fevers 4 2 2 .. .. 1 1 2 1 .. 1 .. .. 1 .. 3 Erysipelas 6 1 4 5 .. .. .. 5 .. .. .. .. .. .. 1 4 Metria, 2 .. 2 .. .. .. .. .. 1 1 .. .. .. 1 .. 1 Childbirth Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 18 9 9 14 3 .. .. 17 .. 1 .. .. .. 1 5 12 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 95 48 47 39 41 6 4 90 2 2 1 .. .. 7 40 48 2. Tubercular 69 40 29 15 10 2 5 32 16 18 3 .. .. 3 35 31 3. Of Brain, Nerves,&c. 70 30 40 27 5 .. 3 35 3 13 16 3 5 4 28 33 4. Of the Heart 53 25 28 2 .. 1 3 6 4 17 22 3 7 6 22 18 5. Of Respiratory Organs 07 44 53 31 18 2 1 52 4 12 23 6 3 4 33 57 6. Of Digestive Organs 38 12 26 4 .. .. 1 5 3 13 16 1 5 9 20 11 7. Of Urinary Organs 8 4 4 .. .. .. 1 1 2 2 3 .. 1 3 3 1 8. Of Organs of Generation 2 .. 2 .. .. .. .. .. .. 1 1 .. .. .. .. 2 6. Of Joints, Bones, &c. 4 9 2 2 1 1 2 7. Of Skin 2 1 1 2 .. .. .. 9 .. .. 8 .. .. .. 1 1 8. Premature Birth, Low Vitality, Malformation, &c. 47 31 16 47 .. .. .. 47 .. .. .. .. 2 .. 19 26 9. Of Uncertain Seat 25 11 14 8 1 .. 1 10 2 6 6 1 2 5 7 11 10. Age 22 9 13 .. .. .. .. .. .. .. 9 13 8 1 7 6 11. Violence 11 6 5 5 1 .. .. 6 4 1 .. . . .. .. 4 .. 12. Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 543 263 280 180 78 11 19 288 41 86 101 27 33 35 221 254 50 Ages at death.—53 per cent. of the total deaths occurred at various ages below 20 years, 33 per cent. being under 1 year, and 14.3 per cent. between 1 and 5 years. An enormous loss of life is involved in these figures, of which a large proportion at least is preventible. One-fourth of the deaths under the age of 20 resulted from zymotic diseases; over one-sixth from respiratory diseases, and one-eight from tubercular diseases; all of which are to a large extent under the control of parents and guardians. The increased study of the laws of physiology and health in our public schools will probably lead to a great diminution of this premature mortality. The Infantile death.rate, i.e., the proportion of deaths of infants in the first year of life to registered births was 160 per 1,000, as compared with 147 per 1,000 in all England and Wales, and 155 for the whole of London. Some of the causes of infantile mortality have been alluded to in the last section, but a very important one must be added—improper feeding. The substitution of farinaceous foods for the natural food of infancy is largely responsible for this destruction of children, either by directly exciting diarrhoea, &c., or by leading to a condition of mal-nutrition, which renders the infant incompetent to resist successfully the inclemency of winter and early spring, or the onset of infectious disease. Senile Mortality.—The number of deaths of persons over 60 years was 23.6 per cent. of the total deaths, as compared with 19.7 per cent. in the previous year. On the other hand 23.5 per cent. of the total deaths occurred between 20 and 60 years of age, as compared with 26.4 per cent. in the previous year. The increased senile mortality and the diminished mortality during what are presumably the most useful years of man's life, are both favourable indications of the health of this sub-district. 60 Social position of deceased.—The proportion per cent. of the total deaths, and of deaths from zymotic diseases in relation to the social position of the deceased are shewn in the following table:— Social Position. Total Deaths. Percentage of Deaths. Percentage of deaths from Zymotic class Nobility and Gentry 33 6 0 Professional Class, Merchants, Bankers, &c 35 6.4 7.3 Middle and Trading Classes, Clerks, &c. 221 40.7 42.1 Industrial & Laboring Classes 254 46.9 50.6 No reliable statistics exist as to the number of persons in this sub.district belonging to each of the above classes, and no conclusion can therefore be drawn as to the relative mortality among them. Important conclusions may however be drawn from the comparison of the zymotic and general mortality. It is evident that in the first class there is a remarkable absence of fatalities from zymotic disease, only a slight excess in the second class, while the excess in the middle classes amounts to 1.4 per cent., and in the labouring classes to 37 per cent. This can only mean that in the latter classes there is a greater carelessness regarding infection, and a lack of treatment for such "slight" affections as Measles and Whooping Cough, which yearly carry off many victims. Deaths from Epidemic diseases.—The following table shews the mortality from the seven chief epidemic diseases, as con. pared with the mortality of the ten previous years. The mean zymotic death.rate for the 10 years 1874.84 is 2.57 per 1,000 per annum, while that for the past year is 2.1; including the ten deaths from infectious disease occurring in out.lying Institutions, the zymotic death.rate is 2.3, as compared with 3.34 for the whole of London. 61 Years. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough Fevers—Typhoid and Typhus. Diarrhœa and Cholera. Total deaths from Epidemics. Total deaths from all causes. Zymotic Death Rate General Death Rate. 1874 .. 20 33 4 15 6 27 105 528 3.6 17.9 1875 2 3 22 6 17 2 22 74 548 2.5 18.2 1876 14 13 13 .. 17 5 24 86 545 2.8 17.7 1877 12 5 4 .. 12 4 18 55 467 1.8 14.8 1878 3 23 12 3 29 5 26 103 580 3.2 18.1 1879 .. 17 12 1 25 9 17 81 561 2.4 17.0 1880 2 19 21 3 25 4 36 112 544 3.3 14.9 1881 7 10 15 3 13 3 20 71 499 1.9 13.6 1882 1 15 26 4 17 7 4 74 544 1.9 14.5 1883 .. 33 8 7 16 3 19 86 580 2.3 15.1 1884 2 33 3 8 15 4 18 83 543 2.1 13.7 Measles and Whooping Cough are the two most fatal zymotic diseases. This is not a necessary fact; both these diseases are usually slight and recovery is complete, if the patients are kept warm and unexposed. Such precautions however are often neglected; and isolation of patients suffering from these diseases being seldom enforced, the consequence is that they become widely diffused. In Scarlet Fever much more active precautions are adopted, and the number of fatal cases for the last year is only 3, as compared with 33 deaths from Measles and 15 from Whooping Cough. Unfortunately information respecting but a small minority of the cases is communicated to the sanitary authority. The only definite source of information is the relieving office, and it is evident that only a small proportion of cases can be known of in this way. Until a compulsory registration of infectious diseases is enforced we cannot expect to cope successfully with Scarlet Fever and other epidemic diseases. Diphtheria was the cause of 8 deaths during the year. A careful examination of the distribution of all the fatal cases during the last two years, shews that they are diffused 62 throughout the sub-district, but most numerous in the thickly populated parts. The close connection of Diphtheria with bad house drainage cannot be doubted, and the following case is typical of many others. A child three years old was taken ill with Diphtheria, from which she died after removal to the hospital. The scullery of the house was used as a living room. The only trap between the scullery sink and the drain was a bell trap, and on removing this there was a powerful up current. Even while the bell was in its place an offensive smell was present in the house, to remedy which the mother had been in the habit of keeping a wet cloth over the bell.trap. Such improper connection of waste pipes with the drain is probably one of the commonest causes of Diphtheria (as well as of Typhoid Fever). Until we arrive at the consummation of sewers the contents of which are carried without let or hindrance to the outlet, and thus the development of dangerous putrefactive matters is prevented, it is essential that all waste.pipes except soil.pipes should only be indirectly in communication with the drain, and that the soil.pipe should be freely ventilated. At the same time the importance of frequent flushing of street sewers cannot be exaggerated, and free ventilation of them. This is being done in Clapham, and it is proposed to embrace every opportunity of connecting sewers with the shafts of factories. The number of deaths from Diarrhoea (18) was not so large as might be expected, when we remember that the summer months were exceptionally hot and dry. Deaths from non-zymotic diseases.—The general table on page 58 gives in sufficient detail the causes of death and relative numbers. Respiratory diseases stand at the head of the list, causing 18 per cent. of the total deaths, just exceeding zymotic diseases which cause 17.5 per cent. Diseases of the nervous system come next with 12.9 per cent., being closely followed by Tubercular diseases, which cause 12.7 per 63 cent.; while Circulatory diseases (9.9 per cent.,) and Developmental diseases (8.6 per cent.) are next in importance. Inquests.— twenty-three inquests were held during the year and the following verdicts were returned — 1. From Natural Causes 11 2. Accidental—Injury to Spine by fall 2 Scald 1 Suffocation by over-laying 2 Want of attention at birth 2 7 3. Suicidal—Drowning 3 Shooting 1 4 4. Homicidal—Strangulation of new-born child 1 1 Total 23 Uncertified deaths.—Five deaths occurred in which no qualified practitioner had attended during the patients' illness. All these were of children under two years of age, the probable cause of death being stated in three cases to be Convulsions, and in two Acute Laryngitis. An important defect of the Register of Deaths Act may be here alluded to. It is not necessary to register the deaths of any person before burial, but the 17th section of 37 and 38 Vict. Cap. 58 provides that the person who buries or performs any religious service for the burial of any dead body as to which no order or certificate under this section is delivered to him, shall within seven days after the burial, give notice thereof to the Registrar, and if he fail to do so shall be liable to a fine not exceeding £10. In the case which drew attention to this defect in the Act, the parents, who were unmarried, only lived two days in this sub-district before their child died. They then took the body to Chelsea, obtained a death certificate from a medical man who had previously known the child, and subsequently buried the child at Hanwell. A week after the burial and two weeks 61 after the death, a mis-directed post-card was received by the Local Registrar from the person who officiated at the burial, baldly stating this fact. It is evident that such a conjunction of circumstances renders evasion of investigation ir. suspicious cases a comparatively easy task. Sanitary proceedings of the year.—The past year has been marked by a more thorough and systematic inspection of the houses in this sub.district, than any of its predecessors. At each house careful enquiries are made as to the presence of overcrowding, infectious disease, or any special nuisance, in addition to a careful examination of traps, closets, and cisterns. The thoroughness of this inspection may be gathered from the fact that out of 2,270 houses inspected, 954 notices to remedy sanitary defects were served on owners and occupiers, and 721 drains were repaired or trapped. Considerable delay in executing the necessary repairs occurred in a large proportion of cases, landlords frequently evading the notices or only partially executing the works. In only 21 cases however was it necessary to have recourse to the Magistrate in order to obtain compulsory orders. It is unfortunate that the necessary preliminaries to legal proceedings take up so much time, and that even after the case is brought before the Magistrate, it is so frequently" adjourned for 14 days "to give the delinquent a further breathing time. In nine cases pig-keeping has been prohibited. In one instance pig.keeping was prohibited by the Magistrate in a piggery, which was 17 yards distant from the nearest house, although the pigs were kept in as cleanly a condition as seems possible. Action was taken in all cases under the Metropolis Management Act, 25 and 26 Vict. c. 102, s. 91, which gives the Magistrate power to prohibit the keeping of pigs in unsuitable places, and does not necessitate the proving of the existence of a nuisance. It is to be hoped that the favorable decision of these cases will lead to the general abolition of piggeries in this sub-district. 65 Overcrowding has only been discovered in twelve instances. Some difficulty arises however in obtaining correct information, especially when previous notices concerning overcrowding have been served in the same street Repairs have been ordered in 380 dilapidated houses. Defective roofs, and rain-water gutters, and unpaved back yards have similarly engaged attention. These, spite of magisterial remarks to the contrary, are undoubtedly sanitary defects. They certainly favour through the dampness developed, if they do not produce Consumption and Rheumatism; and we know no reason why these complaints should not be brought under the preventive power of the Sanitary Authority. Disinfection of houses in which Scarlet Fever or Small Pox has occurred, has been effected in 44 cases by burning sulphur. In 21 cases the bedding was subsequently burnt. The recurrence of Small Pox in two families in which bedding had been burnt and rooms fumigated after the removal of the first cases to the Small Pox Hospital, led one to suspect some defect in the method of disinfection. A careful examination of dates in each case however proved that the remaining inmates received the infection before the patients were removed to the hospital, and therefore before disinfection was effected. The fault lay in the lack of isolation prior to removal, and not in the disinfection. Unfortunately in many of these cases the inmates of an infected house decline to purchase immunity by re.vaccination. Bakehouses have been periodically visited, and except a few instances where lime-washing was required, have been found in a sanitary condition. The Factory Act of 1883 (46 and 47 Vict. c. 53, s. 15), requires that any cisterns supplying water to a bakehouse shall be separate and distinct from any cistern for supplying water to a water closet. In a bakehouse in Wandsworth Road the vigilance of the Inspector discovered an evasion of this important regulation. Two taps 66 were found in the bakehouse one supplied directly from the main, the other from the cistern which also supplied the water-closet. It was asserted that the water used in baking was taken from the first source; but on enquiring when the "sponge" was made, this was found to correspond to a time when the water was turned off at the main. Cisterns have received a large amount of attention during the past year, 571 having been repaired and cleansed. The placing of cisterns in inaccessible positions under the roof, without a cover, has been found to be a frequent source of foul drinking water. Dead birds, mice, birds' excrement, &c. are not infrequently found in such cisterns, and the difficulty in reaching them prevents efficient cleansing. There can be no doubt that when drinking water is the source of diseases, it is generally if not always due to contamination received in the house or its annexa, rather than to the quality of the water as delivered by the Water Companies. As an instance of the anomalous character of sanitary legislation, may be mentioned the prohibition of the water supply for baking purposes being obtained from a cistern which also supplies a water-closet; while no such enactment is in force for water which has not undergone the at any rate partial protection of being baked. It is still extremly common in Clapham for one cistern to supply water for drinking and for flushing the closets, thus providing in case of accidental emptying of the cistern a ready passage into it of foul gases from the closet. Whether a separate service.box for each closet can be legally enforced remains to be proved. ARTHUR NEWSHOLME, M.D., Medical Officer of Health for Clapham. 67 PUTNEY & ROEHAMPTON. The health of this sub-district, during the year 1884, judged by the statistics which will be afterwards given, has been exceptionally good, and this notwithstanding the fact that diphtheria had not entirely disappeared during the earlier part of the year. 1 he accidental prominence which that disease gave to our mortality during the previous year, has been more than compensated for, by the very low zymotic mortality of the present year. Population.—At the middle of 1884 the population of this sub-district may be estimated at 14,450. This is obtained by adding three years and a quarter's increase to the ascertained population at the census of April 4th, 1881; but as this increase is calculated upon the rate of growth, which prevailed during the ten years preceding the census, the estimate based upon it, is probably too low, the discrepancy becoming greater in a progressive district such as this year by year. Births and Birth-rate.—The number of children born in the sub-district during 1884 was 367,—181 males and 186 females. The birth-rate was 25.3 per 1,000, a rate rather below the average for this district, and no less than 8.5 per 1,000 less than the birth-rate of London, and 9.3 less than the birthrate for the twenty-eight largest towns of England. This low birth-rate is always found in districts inhabited by the wealthier classes, and goes to prove that luxury is inimical to increase of population. 68 Deaths and Death-rate.—The mortality from all causes during the year 1884 amounted only to the low figure of 199. This yields a death-rate of 13.7 per 1,000. We have reason for congratulation that such an exceptionally good year should follow the somewhat high mortality of last year. From the table below the death-rate of this year will be found exactly 1.0 less than the average of the eleven years 1874.84. YEARS. Births. Birth.rate. Number of deaths from all classes. Death.rate. Rate of Natural Increase. 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 1884 377 25.3 199 13.7 11.6 It is also nearly 7 per 1,000 less than the death-rate of London, and 8 per 1,000 less than that of the 28 largest towns. With one exception (Barrow in Furness) it is lower than any of the death rates quoted in the Registrar General's summary. The difference between the number of births and deaths amounted to 168. This constitutes the natural increase of the population and amounts to 11.6 per 1,000. The table which follows is, in an abridged form, the same as that employed by the Registrar-General, and also arranged according to the classification of diseases drawn up by the College of Physicians of London, for use in certifying the causes of death. Some sub-classes, which appeared to me unnecessary, have been omitted, and others which I deemed useful in classifying the causes of death, adopted. 69 PUTNEY and ROEHAMPTON. Total Deaths from each Class of D1sease, &c., 1n the Sub-D1str1ct. Sex. Age. Soc1al Pos1t1on. Males. Females. 1 Under 1 year. From 1 to 5 years. From 5 to 10 years. 1 From 10 to 20 years. At 20 and under 40 years of age. At 40 and under 60 years of ape. At 60 and under 80 years of age. 80 years and upwards. Nob1l1ty and Gentry. Profess1onal Class, Merchants, Bankers, &c. M1ddle & Trad1ng Class, Shopmen, Clerks, &c. 1ndustr1al and Labour1ng Classes. Populat1on (Census) 1881 13,221. Off1c1al Populat1on 1n m1ddle of the year 1884 14,450. Area 1n Statute Acres-2,176. D1SEASES, And other Causes of Dath. Classes:— Small-pox 1 1 .. .. .. .. .. 1 .. .. .. .. 1 .. .. 1. Zymotic Measles 1 .. 1 .. 1 .. .. .. .. .. .. .. .. .. 1 Scarlat1na .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 10 6 4 .. 6 3 1 .. .. .. .. .. 1 5 4 Typhoid and Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Remittent and other Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 8 7 7 5 3 .. .. .. .. .. .. .. .. .. 8 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa, Dysentery, & Cholera 8 2 6 7 1 .. .. .. .. .. .. .. .. 1 7 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 28 10 18 12 11 3 1 1 .. .. .. .. 2 6 20 11.Constitutional Gout, and Rheumatism 5 3 2 .. .. .. 1 2 2 .. .. .. .. 2 3 Cancer and other Tumours 5 .. 5 .. .. .. .. .. 2 2 1 2 1 .. 2 Tubercular 24 17 7 1 6 2 1 10 4 .. .. .. 2 7 15 III. Local Nervous 39 22 17 11 4 1 1 3 4 1n 5 3 3 14 19 Circulatory 11 4 7 .. .. .. 1 3 3 3 1 .. 1 4 6 Respiratory 31 31 18 14 3 .. .. 3 2 8 1 2 1 8 20 Digestive 12 9 3 2 3 .. 1 3 1 2 .. .. 1 4 7 Urinary 10 8 2 .. .. .. .. 2 3 .. .. 1 4 4 1 Generative 1 .. 1 .. .. .. .. 1 .. .. .. .. .. 1 .. Locomotory .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumentary 2 1 1 .. 1 .. .. .. .. .. 1 1 .. .. 1 IV. Devel. opmental Premature B1rth, Atro. phy, &c. 13 10 3 12 1 .. .. .. .. .. .. .. 1 3 9 Old Age 7 2 5 .. .. .. .. .. .. 1 6 .. 3 3 1 V. Violence 11 7 4 .. .. .. 2 4 4 1 .. .. .. 4 7 Totals 199 105 94 52 29 6 8 32 25 32 15 9 19 60 111 70 Zymotic Diseases.—The following table gives a comparative view of this group during the eleven years 1874—84, and it will be seen that the year under review compares favourably with the other years of the series. A total of 28 deaths from the chief epidemic diseases occurred out of 199 deaths from all causes. The percentage is only 14.07. Whooping Cough was somewhat prevalent, and Diarrhoea claimed about its usual number of victims. The other diseases were hardly represented at all with the exception of Diphtheria. Yeaes. 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 l884 Small-Pox .. .. 1 .. 1 .. .. .. .. .. 1 Measles 3 .. 1 2 7 .. .. 6 13 2 1 Scarlatina .. .. 3 6 .. 3 1 8 4 7 .. Diphtheria 1 4 .. 1 1 .. .. 1 29 24 10 Whooping- cough .. 9 7 .. 4 8 9 3 8 2 8 Typhoid &c .. .. .. 4 3 2 4 1 4 2 .. Diarrhœa & Cholera 6 7 5 7 10 7 10 3 5 5 8 Total 10 20 17 20 26 20 24 22 63 42 28 Percentage of Deaths from to deaths 6.4 11.9 18.2 13.0 13.8 11.2 13.5 13.17 30.1 17.3 14.07 from all causes. This disease was unhappily both prevalent and fatal during the year 1882, and almost equally fatal though much less prevalent during the following year. At the commencement of the present year isolated cases continued to occur without anything approaching an epidemic existing. These still maintained the severe type of the preceding year, and the fatal cases held an unusually high ratio to the total number of cases, which were really few and scattered, 71 In the table below it will be seen that three fatal cases of diphtheria occurred during the first quarter, six in the second, one in the third and none in the fourth. DISEASE. 1884 First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Mean Temperature 43.4 52.5 62.7 44.1 Small-Pox .. .. .. 1 Measles .. 1 .. .. Scarlatina .. .. .. .. Diphtheria 3 6 1 .. Whooping Cough .. 6 2 .. Diarrhœa .. .. 8 .. Fever .. •• •• .. Total 3 13 11 1 There is reason to believe that the disease died out about the middle of the year. The causation of such an outbreak of zymotic disease is of great importance to the inhabitants of this sub-district, and the subject has given me no little thought and concern. The inherent difficulty in tracing out the causes of a disease, the nature and history of which are not yet thoroughly understood is one which the medical profession fully recognises. This difficulty is increased by the obstruction to most sanitary operations on the part of the public, and by the natural hostility of those whose interests are likely to be affected by any inquiry or the changes which may arise from it. One supposed cause which naturally excited anxiety then and now was the condition of the sewers in the district, but the careful examination to which of course they were subjected, revealed no serious defect in the system. No changes were required in their construction or management, and yet the disease has died out, a fact strongly bearing out the opinion that the cause could not be traced to them. In every case as 72 far as practicable inspection was made of the sanitary arrangements of the house in which it occurred, and in many obvious defects were found. We are bound to admit however that in many cases no fault could be found in the sanitary condition of the house, and the selection often of the individual least exposed to sanitary dangers in the household, compelled us to look elsewhere for the cause of the disease. The system of ventilation of the sewers by gratings in the open street (often near frequented places such as crossings, &c.) which obtains in most parts of London is not devoid of danger, and will have to be replaced sooner or later by some safer method. The accumulation of house refuse in stationary receptacles close to dwelling houses, is in my opinion a not improbable source of danger. The time is surely not very distant when the daily removal of household refuse (often of a highly decomposible nature) will be undertaken by the sanitary authorities themselves, and not by contractors who have no interest in its frequent removal. Atmospheric conditions must not be forgotten as a probable cause of diphtheria. It has several times been observed that an epidemic of this disease has followed a continuance of dry weather. The charging of the air with dust containing organic impurities may at such times lead to the disease in those who have weak throats and enlarged spongy tonsils. The absence of water leads of course to defective flushing of the drains and the drying up of traps dependant upon the rain.fall for their effectiveness. Constitutional and Local Diseases, &c.—Very little requires to be noted regarding these groups which maintain much the same proportion as in previous years. In the following table the usual eleven years' comparison will be found. 73 Years. 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 1884 C Gout & Rheumatism .. .. .. .. 3 1 4 4 4 5 5 Cancer and Tumours .. .. .. .. 7 3 6 1 6 8 5 Tubercular 24 26 26 26 32 23 18 17 12 28 24 L Nervous 39 23 26 29 28 34 33 21 33 34 39 Circulatory 8 13 6 8 12 13 13 14 12 14 11 Respiratory 30 36 23 29 37 42 27 24 29 30 31 Digestive 11 7 5 12 10 9 13 17 15 15 12 Urinary 3 8 7 11 2 4 6 2 6 6 10 Generative .. 1 1 2 .. 1 .. 2 2 4 1 Locomotory .. 1 1 2 .. .. .. .. .. .. .. Integumentary .. .. .. 1 .. 2 1 1 1 .. 2 D Permature Birth, Atrophy, &c. 7 16 10 8 7 8 16 18 7 17 13 Old Age 6 11 8 8 7 5 9 6 5 10 7 V —Violence 6 4 7 9 5 7 6 13 7 15 11 (Other diseases) 12 1 1 3 .. .. .. .. .. .. .. Totals 146 147 121 148 150 152 152 140 139 196 171 Ages of the deceased.—During 1884, 52 children under one year died, giving a percentage of 26.1 of the total deaths. The percentage in 1883 was 17.8, but of the two previous years it was 28.7 and 30.0 respectively. The small number of deaths between five and twenty is somewhat remarkable, namely, 14. A smaller number of deaths of persons upwards of 60 years occurred during the present year (namely 47; than last year. The percentage was 23.6. The year was mild and dry, conditions favourable to life in the aged. Social Position.—The various classes of the community are proportionally represented in the following table. Nobility and Gentry 4.5 Professional and Merchant Classes 9.5 Middle, Tradesmen, &c. 30.0 Industrial 56.0 100.0 Amongst zymotic diseases diphtheria alone had a preference for the well-to-do classes, other diseases of the group fell most 74 heavily upon the poor. Cancer, Nervous Diseases, Urinary Diseases and of coursa old age were most prevalent among the better classes. Tubercular and Respiratory diseases and the deaths due to premature birth and violence chiefly affect the poorer classes. Inquests, &c.—Fifteen inquests were held during the year 1884. The following are the verdicts classified as usual. I. Natural.—Suffocation, 1; Syncope, 1. II. Accident.—Drowning, 2; Injuries to Ribs, 1. III. Suicide.—Strangulation, 2. IV. Open.—Found Drowned, 6; Found Dead, 2. Fourteen inquests will be found in the Registrar-General's annual summary as the number from this sub-district, but one was omitted to be notified as such by the local Registrar The deaths from drowning form the most prominent feature amongst the violent deaths of this locality; and it is my duty as I did last year to point out to the police authorities the special dangers of the river at the present time. The building of the new bridge has undoubtedly increased the risks from this cause during the past and the present year. Sanitary Proceedings.—In Table VI. Appendix will be found a tabulated statement of the sanitary work carried on during the year. For the first time we have had the services during the present year of a separate sanitary officer. The advantage of having an Inspector of Nuisances is obvious. Indeed the labour of the last twelve months in the matter of house inspection, &c , could never have been undertaken without the aid of an officer who could devote his whole time to the work. All the smaller property and many of the larger houses have been not only once but several times examined and reported upon, and a multitude of defects more or less serious discovered and rectified. Still much remains to be done, and I would earnestly call upon the inhabitants of this sub.district 75 to invite the aid of this officer to discover in their own private dwellings any conditions dangerous to health. His nervices are rendered gratuitously and willingly and might be of infinite value in finding out sources of danger before disease or perhaps death have laid hold upon the inmates. The larger and newer houses are often more open to sanitary dangers than the smaller and older ones from the multiplication of conveniences such as wash-hand basins, baths, &c. It must not be forgotten that mere cleanliness is no guarantee against such risks. During the year all the bakehouses have been carefully inspected by the Surveyor and myself, and our reccommenda. tions have been carried out in those requiring attention without serious difficulty. The cow and slaughter.houses also were inspected by me and fairly carried out the provisions of the law. In some of the former however I would like to see the water supply removed from the atmosphere of the cow-house. Deaths in Public Institutions.—During the year 30 deaths occurred in various public institutions of persons removed from this sub-district. These are tabulated as below. DISEASE. Total. Sex. Age. Class. Institutions. Males Females. Under 1. 1 to 60. 60 & upw'ds. Middle. Industrial. Union Infirmary. Infectious Hospitals. General Hospitals. Small-Pox 2 2 .. .. 2 .. .. 2 .. 2 .. Erysipelas 1 .. 1 .. .. 1 .. 1 1 .. .. Nervous Disease 2 .. 2 .. 2 .. .. 2 1 .. 1 Lung Disease 11 8 3 .. 7 4 1 10 7 .. 4 Heart Disease 3 2 1 .. 2 1 .. 3 2 •• 1 Cancer 3 2 1 .. 4 .. 1 3 2 .. 1 Urinary Disease 3 2 1 .. 2 1 1 2 2 .. 2 Other Diseases 5 2 3 .. 2 2 1 3 2 .. 3 Total 30 18 12 •• 21 9 4 26 15 2 13 76 This increases the number of total deaths of parishioners to 229, giving a total death-rate of 15.8. As however many of these persons had resided for years in the institutions, they cannot properly be included in the mortality returns of the parish from which they originally came. ALEXANDER WALKER, M.D., Medical Officer of Health for Putney and Roehampton. 77 STREATHAM, INCLUDING BA.LHAM AND TOOTING. It is gratifying to be able to give a favourable report of the public health in this sub-district during the year 1884. The birth-rate was a high one and points to a larger population than the official estimate would account for. The death-rate was below the death-rate of the healthiest rural districts. There was no prevalent epidemic disease and the death-rate from the seven principal diseases in this class was very low. This decrease in the prevalence of and fatality from infectious diseases in an increasing neighbourhood, with a larger migratory population than formerly is an indication of good sanitary supervision and control, and the Board and its Officers may be congratulated on the results of the care and vigilance manifested in the prevention of the spread of contagious diseases and on the improved sanitary condition of dwelling houses whereby the moral, physical, and social condition of the people is raised and a higher standard of health-attained. 78 The following statistics derived for the most part from an analysis of the Registrar-General's Returns and from the local records of sickness, mortality, and sanitary operations will, I believe, corroborate these observations and disclose more fully the state of the public health in Streatham and Tooting during the year 1884. Vital Statistics. Population.— Assuming the population of Streatham and Tooting to have increased in the same ratio as obtained in the ten years previous to the last census, it would amount to 29,149 in the middle of the year 1884. As I have pointed out in former reports this, the official method of calculation, does not sufficiently account tor the increase of population from immigration into this rapidly growing locality; I am disposed to think, judging from the large number of new houses that have been built since the census in 1881 and from the very high birth-rate of the year under review, that the population exceeds the official estimate by probably 2,000 and this under-estimate should be borne in mind when the death-rate is considered, as both the birth.rate and the death.rate are calculated from the official estimate of the population. Births & Birth-rate.—There were 1,138 births registered during the year—544 of males 594 of females. The birth.rate calculated from the total number of births and the foregoing estimate of the population was 39.2 per 79 1,000 persons living in the year. The births exceed those of the previous year by 111. The number registered in each quarter was as follows:— First quarter, 265; second quarter, 291; third quarter, 280; fourth quarter, 302. Natural increase.—The natural increase, as represented by the excess of births over deaths was 693, giving the high ratio of 23.9 per 1,000 of the population. Deaths & Death-rate.—The number of deaths registered throughout the year was 445—218 of these were of males, and 227 of females. The death-rate calculated from the total number of deaths and the official estimate of the population was 15.3 per 1,000 persons living during the year. This, though slightly above the average death-rate of this sub-district is a very low one, and is in point of fact, 1 per 1,000 below the death.rate of the healthiest rural districts. The number of deaths in each quarter was as follows:— First quarter, 119; second quarter, 110; third quarter, 112; fourth quarter, 104. Deaths in Public Institutions.—Thirty-eight deaths took place in outlying Institutions; if these are added to the 445 deaths actually occurring in the sub-district the death-rate will be increased to 16.6 per 1,000 of the population. 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. 80 STATISTICS OF MORTALITY. STREATHAM, including TOOTING & BALHAM. Total deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 29 years, including all tinder 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 ape. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c Industrial and Labouring Class. Population (Census) 1881 25,553 Official population in middle of 1884 29,149 Area in Acres 3,466 DISEASES, And other causes of Death. Classes:— 1. Zymotic Small-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 8 5 3 3 1 1 8 .. .. .. .. .. 1 3 4 Scarlatina 8 5 3 1 5 1 7 1 .. .. .. .. 2 3 3 Diphtheria 3 1 2 .. 1 1 3 .. .. .. .. .. 3 .. .. Croup 2 2 .. .. 2 .. 2 .. .. .. .. .. .. 2 .. Whooping Cough 9 3 6 6 3 .. 9 .. .. .. .. 2 .. 2 5 Typhus and other Fevers 4 3 1 .. 1 .. 1 2 1 .. .. .. .. 1 3 Erysipelas 2 .. 2 1 .. .. 1 .. 1 .. .. .. .. .. 2 Metria Childbirth 6 .. 6 .. .. .. .. 5 1 .. .. .. .. 2 4 Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa & Choleraic Disease 11 7 4 9 1 .. 10 .. 1 .. .. .. 2 3 6 Totals of Zymotic Class 53 26 27 20 14 3 41 8 4 .. .. 2 8 16 27 2. Tubercular 58 33 25 12 9 3 25 22 11 .. .. 2 6 20 30 3. Of Brain, Nerves, &c. 67 36 31 14 14 4 33 4 6 19 5 11 3 21 32 4. Of the Heart, &c. 35 22 13 1 .. 1 3 3 12 15 2 8 2 14 11 5. Of Respiratory Organs 71 29 42 13 16 1 31 5 10 24 1 4 9 28 30 6. Of Digestive Organs 45 18 27 5 5 1 12 4 11 16 2 8 8 13 16 7. Of Urinary Organs 13 7 6 .. .. .. .. 1 6 5 1 3 5 1 4 8. Of Organs of Generation 9 .. 9 .. .. .. .. .. 5 4 .. .. 6 .. 3 9. Of Joints, Bones, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10. Of Skin 1 .. 1 1 .. .. 1 .. .. .. .. .. .. .. 1 11. Premature Birth, Low Vitality, Malformation, &c. 55 29 26 55 .. .. 55 .. .. .. .. .. 8 12 35 12. Of Uncertain Seat 9 2 7 .. 1 .. 2 .. 3 4 .. 1 1 3 4 13. Age 19 7 12 .. .. .. .. .. .. 9 10 4 2 12 1 14. Violence 10 9 1 2 2 .. 4 2 1 1 2 1 1 2 6 16. Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 445 218 227 122 31 13 207 49 69 97 23 44 59 142 200 81 Zymotic Diseases—their prevalence and fatality. The total number of deaths in this class was 53 as against 65 in 1883—26 of these were of males and 27 of females. They yield a per centage of 12.0 as against 13.1 in the previous year upon the number of deaths from all causes during the year, and give a rate of l.82 per 1,000 of the population. The following table contrasts all the deaths which resulted from the seven principal epidemic diseases during the first ten years. DISEASE. 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 1884 Seven principal Epidemics Small-pox 2 .. .. 4 1 .. .. .. .. .. .. Measles 9 2 2 2 11 2 1 3 5 7 8 Scarlatina 3 4 4 1 2 5 34 13 9 2 8 Diphtheria 1 3 7 3 3 2 7 1 4 13 3 Whooping Cough 3 5 7 6 11 21 8 9 9 11 9 Typhus, &c. 2 2 5 5 1 3 5 2 1 8 4 Diarrhæa and Choleraic Disease 6 9 6 4 13 3 6 9 3 9 11 Totals 26 25 31 25 42 36 61 37 31 50 43 From this table it will be seen that there were 43 deaths amongst the seven principal epidemic diseases. This number is below the decennial average allowing for increase of population, and without such correction it is below some years of the series. The table shows also that there was no death from Small-pox and that the deaths from Scarlet Fever, Typhoid and Diphtheria, were below the average. The mortality from these especially preventible diseases was exceedingly low, nor were they ever epidemic, though they occurred sporadically during the year, and 3 cases of Small-pox and 30 of Scarlet Fever were sent into Hospital, where 3 cases of the latter died. It is in a great measure due to the early removal of these cases with 82 subsequent disinfection and other sanitary measures that these diseases did not become epidemic and to the same cause the low Zymotic Mortality must be ascribed. Measles, Whooping-cough, and Diarrhœa contributed 8, 9, and 11 deaths respectively. Altogether the seven principal diseases in the Zymotic class form 9.7 per cent of deaths from all causes and yield a rate of 1.48 per 1,000 per annum of the population. Other Diseases.—The table given below contrasts all deaths from non.zymotic diseases. Taken collectively the number exceeds the decennial average. The mortality in class 3, diseases of the brain and nerves; and in class 5, respiratory diseases was considerably above the average, as it was also in class 11; in this latter class there were 55 deaths, forming 12.5 per cent of all causes of death as against 9.0 per cent in 1883. In the Tubercular class there were 58 deaths, 30 of which were from Phthisis pulmonalis—16 of males and 14 of females. 4 were under 20, 17 between 20 and 40, and 9 were over 40 years of age. The Tubercular class formed 13.4 per cent of all deaths as against 13.6 per cent last year. The diseases in classes 3, 4, 5, 6, 11, and 13, caused respectively and in order 15.2, 7.9, 16.1, 10.2, 12.5, 4.3 per cent., as against 14.3, 11.4, 14.8, 10.7, 9.0, 7.8 per cent. in the previous year. Thus only in classes 4, 6, and 13, was the per centage below that of the year 1883. The following Table contrasts all deaths from non.zymotic diseases during the past nine years. 88 Years 1876 1877 1878 1879 1880 1881 1882 1883 1881 Tubercular 31 23 30 32 38 38 34 56 58 Of Brain, Nerves, &c. 39 33 57 41 54 41 49 59 67 Of the heart, &c. 18 33 31 34 17 26 32 47 35 Of Respiratory Organs 52 36 44 64 52 48 59 50 71 Of Digestive Organs 22 25 29 16 25 33 42 44 45 Of Urinary Organs 6 7 7 10 5 10 6 11 13 Of Organs of Generation 6 11 2 1 5 8 7 5 9 Of Joints, Bones, &c. 2 7 2 .. 3 2 1 5 • • Of Skin .. 2 .. 1 .. l .. .. 1 Premature Birth, Low Vitality, Malformation, &c. 14 15 17 19 37 29 26 37 55 Of Uncertain Seat 2 4 3 6 9 2 7 2 9 Age 23 14 17 12 25 20 29 32 19 Violence 9 5 3 13 11 9 8 6 10 Not Specified 1 .. .. .. •• .. .. •• •• Totals. 225 215 242 249 281 267 300 354 392 Age at death.—Infant mortality.—The mortality in early life was high, 207 of all deaths occurred before the age of 20. No less than 55 of these were attributed to premature birth, low vitality, and malformation. Diseases of the respiratory organs, of the brain and nerves, and tubercular affections were largely represented amongst the deaths in early life; and there were only 41 deaths in the Zymotic class as against 53 in the previous year, 27.7 per cent of all deaths were of infants in the first year of life; 34.7 per cent were of children under five years of age, and 47 per cent were of young persons under 20 years of age. Senile mortality.—The mortality amongst aged persons was high, though only 19 died solely from old age, but 120 died at 60 and upwards; 57 of these were upwards of 70, 20 were over 80, and 1 was 97. Of the persons who died at and upwards of 70—22 were males and 35 females. Sickness & mortality amongst the out-door poor of the parish.— Table V. in the Appendix shows the number of persons who were under treatment, the nature and extent of the sicknes 84 that prevailed, as well as the deaths that took place amongst the out-door parish poor; 227 new cases were under treatment during the year. There were 56 in the zymotic class, including 3 cases of Small-pox, 30 of Scarlet fever, 1 of Typhoid fever, and 1 of Measles, 1 of Whooping-cough, 11 of Diarrhœa and Dysentery, and 1 of Puerperal fever. The Fever and Small-pox cases were all sent into Hospital, where 3 of the former died. In the other classes there were 2 deaths. The ratio of deaths to cases treated was only 1.5 per cent. Social position.—The following table gives the per centage of deaths in the various classes during the year:— Nobility, Gentry 44 = 10 per cent. Professional Class 59 = 13.40 „ Middle and Trading Class 142 = 32.27 ,, I ndustrial and Labouring Class 200 = 45.13 ,, Total deaths in 1884 445 100. The per centage of deaths was above the average in the trading class and lower in the industrial class. Inquests, Violent deaths, &c.—Twelve Inquests were held with the following results:— I. Natural Convulsions 1 Failure of heart 1 Epileptiform Meningitis 1—3 II. Accidental Found dead 1 Broken leg 1 Suffocated in bed 2 Scalded with hot water 1 Run over by waggon 1 Fall on pavement 1—7 III. Suicidal Cut throat 1 Poison ,, 1—2 12 85 Uncertified deaths.—Seven deaths were uncertified, which were all submitted to the Coroner before being registered as having probably died from the following causes:— Bronchitis 3 Convulsions 2 Heart Disease 1 Laryngismus 1 7 Sanitary Proceedngs.—An abstract of the Sanitary works of the year will be found in Table VI. in the Appendix. On referring to this Table it will be seen that the zeal and diligence manifested in the inspection of dwelling-houses in the year 1883 were fully maintained, and that no less than 4,944 houses and premises were inspected; numerous defects were brought to light and corrected, 3 33 notices were served for the abatement of nuisances. The fig ures in respect of overcrowding, abolished cesspools, new and repaired waterclosets, trapped, and obstructed drains, new dust-bins, pig nuisances, and the removal of accumulations of offal, manure, &c., are high as compared with last year, and show that great activity prevailed in this direction. Thirty-two houses were fumigated, disinfected, and cleansed after the occurrence of contagious diseases; 16 were so treated after Scarlet fever, 6 after Small-pox, 6 after Typhoid, 3 after Diphtheria, and 1 after Puerperal fever, and in no instance was there a recurrence of the disease. I think great credit is due to Mr. Phemister, the Inspector of Nuisances, for the very efficient manner in which these Inspections and other Sanitary works were carried out. The Bakehouses, Cowsheds and Slaughterhouses were duly inspected, improved where required, and the necessary licenses were granted or renewed. F. F. SUTTON, M.D. Medical Officer of Health fur Streatham Tooting. 86 WANDSWORTH. The health of this sub-district during the year 1884, although affected by a greater mortality than during the year preceding, was in a satisfactory condition, and bears favourable comparison with that maintained on an average of the preceding ten years, both as regards the amount of mortality and the prevalence and fatality of epidemic disease. The deaths that resulted from the latter and the proportion that they bore to the total deaths were very considerably less than the average number. Detailed evidence of these conclusions will be found in the following statistics derived as usual from an analysis of the Registrar General's Returns and of the parochial Records of Sickness and Mortality. vital statistics. Population.—Estimated according to the official method of calculation, which assumes a continuance during the year under review of the same rate of increase of the population that prevailed during the preceding ten years, the mean number of inhabitants of this sub-district during the past 87 year amounted to 30,675. The unprecedentedly great in crease in the number of births however which will be subseq uently shewn to have taken place during the year indicates a large accession to the population by immigration. Such increase is otherwise inexplicable ; for it was far too great to have been due to a higher rate of natural increase, any excess moreover in this direction being very improbable from the circumstance that the birth-rate for all London was the lowest recorded since 1860. Mortality.—The total deaths registered during the year were 576 in number = 284 of males and 292 of females, and were slightly below the average; for had the same rate of mortality that prevailed during the preceding ten years continued during the past year, the deaths in the latter, allowing for increase of poplation would have numbered 580. No less than 126 of the deaths occurred in public institutions situated within the parish, viz :—in the Surrey County Lunatic Asylum, 98; in the Hospital for Incurables, 15; in St. Peter's Hospital, 3; in the Prison, 9; and in the Patriotic Asylum for Girls 1: and 62 deaths of Wandsworth parishioners took place in the Union Infirmary and various Metropolitan Hospitals located without the parish. Death-rate.—Calculated from the fore-going estimate of the population and the total deaths registered, the death-rate was 18.77 per 1,000 persons living on an average during the past year. Inclusive of the deaths of parishioners that took place in institutions without the parish the rate was 20.81 per 1,000. Both of these calculations, however, as explained in previous Reports, fail to represent the natural death-rate of the sub-district, inasmuch as they include the deaths 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 necessarily 88 subject to a very high mortality: The amount of the latter alone, indeed, which during the past year exceeded twenty per cent of all deaths, is sufficient to render valueless any deduction of the death-rate derived solely from the registered mortality unless the disturbing influences referred to be taken into consideration. In order therefore to determine the natural death-rate ot the sub-district it is necessary to withdraw from the calculation the population and mortality of the above-named institutions and to add to it the deaths of Wandsworth inhabitants that took place in Hospitals and other institutions situated without the parish. Calculated in accordance with the foregoing conditions the death-rate ot the past year was 17.88 per 1,000 of the estimated population. Exclusive of the 19 deaths that occurred in the general Hospitals the rate is 17.23 per 1,000, and is more properly comparable with the recorded death-rates of previous years which until last year, did not include those deaths; for the latter are always more than compensated by the deaths of persons who have come into the sub-district during the year. (Exclusive of the deaths occurring in the various institutions in Wandsworth, and of those belonging to this sub-district which occurred in out-lying institutions, the death-rate was 14.67 per 1,000.) Births, Birth-ratRate of natural increase.—The total births registered were 1,072 = 562 of males and 510 of females and were 137 above the preceeding decennial average number corrected for increase of population. Determined by the preceeding estimated population the Birth-rate was 36.72 and the rate of natural-increase 18.84 per 1,000 persons of all ages. The following table will be found to contain, as usual, a nosological classification of all the causes of death, shewing the sex, age at death at several periods, and the social position of the deceased; and specifying the different diseases of the zymotic class:— 89 STATISTICS OF MORTALITY. WANDSWORTH. Total Deaths from each class of Diseases, &c., in the Sub-District. Sex. Age. Social Position. Population (Census) 1881 28,004 Official Population in middle of 1881 30,675 Area in acrea, 2,478 Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. All under 20 years. At 20 and under 40 years of ape. At 40 and under 60 years of ape. At 60 and under 80 years of ape. 80 years and upwards. Nobility and Gentry. Professional Class Merehnnts, Bankers, &c. Middle and Trading Classes Shopmen, Clrks, &c. Industrial and Labouring Classes. Diseases and other Causes of Death. Classes:— Smallpox 1 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 Measles 6 4 2 1 5 .. 6 .. .. .. .. .. .. 1 5 Scarlatina 5 .. 6 .. 5 .. 5 .. .. .. .. .. .. .. 5 Diphtheria 4 2 2 .. 3 1 4 .. .. .. .. .. .. 1 3 Whooping Cough 17 10 7 11 6 .. 17 .. .. .. .. .. .. 6 10 Fevers 4 1 3 1 .. .. 2 1 1 .. .. .. .. 3 1 1. Zymotic Diarrhœa & Dvsentery 27 11 16 21 3 .. 24 1 1 .. 1 2 .. 5 20 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas Metria 6 2 4 .. 1 •• 1 •• 2 2 1 1 .. 2 3 Childbirth 2 .. 2 .. .. .. .. 2 .. .. .. .. .. 1 .. Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup 7 3 4 .. 7 .. 7 .. .. .. .. .. .. l 6 Other diseases 4 4 •• 4 .. .. 4 .. .. .. .. .. .. .. 4 Totals of Zymotic Class 83 38 45 38 30 1 70 4 5 2 2 3 2 20 58 l. Tubercular 85 42 43 15 4 2 25 34 24 2 .. .. 5 25 55 Of Brain, Nerves, &c. 128 70 58 20 15 .. 40 22 39 22 5 6 .. 28 87 4. Of the Heart, &c. 22 9 13 1 2 .. 6 4 4 8 .. 1 9 7 1 2 5. Of Respiratory Organs 70 36 34 17 17 .. 36 5 11 17 1 5 4 16 45 6. Of Digestive Organs 47 23 24 11 7 .. 19 8 10 9 1 1 3 13 30 7. Of Urinary Organs 15 9 6 .. .. .. .. 4 3 8 .. 1 4 3 7 s. Of Organs of Generation 3 .. 3 .. .. .. .. .. 2 1 .. .. .. .. 3 9. Of Joints Bones, &c. 2 1 1 .. .. .. 1 1 .. .. .. .. .. .. 2 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Premature birth, low vitality, malformation, &c. 40 21 19 40 .. .. 40 .. .. .. .. .. 1 10 29 12. Dropsy, cancer and, others of uncertain seat 18 8 10 .. .. .. .. 3 6 8 1 1 2 6 9 Age 49 14 28 .. .. .. .. .. 17 24 4 .. 7 29 14. Violence 21 13 8 2 .. .. 4 8 6 2 1 .. .. 4 17 15 Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 576 284 292 144 75 3 241 93 111 96 35 22 32 139 383 90 By far the largest proportion of the causes of death, amounting to more than 22 per cent of the whole, is seen to have resulted from Diseases of the Brain and Nervous System (Class 3); but inasmuch as 76 per cent of the deaths from these diseases occurred in the Surrey County Lunatic Asylum, the inmates of which institution are derived from the whole County of Surrey, it is obviously necessary to exclude this class from consideration in estimating the proportion borne by the several classes of disease in the causation of the mortality proper to this sub-district. Of the other classes, Tubercular diseases (Class 2) including Scrofula and Consumption, were the most fatal constituting 14.7 per cent of all deaths and slightly exceeding diseases of the Zymotic class (Class 1) which unusually occupies the higher position. Next follow in order of fatality, Diseases of the Respiratory Organs (Class 5) forming 12 per cent of all deaths; Diseases of the Digestive Organs (Class 6) 8 per cent; Age (Class 13) 7 per cent'; Premature birth, &c. (Class 11) 7 per cent (nearly); Heart &c. (Class 4) 3-8 per cent; Violence (Class 14) 3.6 per cent; Dropsy, Cancer &c (Class 12)3 per cent; Urinary Organs (Class 7) 2.6 per cent; of individual diseases Consumption was as usual the most fatal. Of the several diseases of the foregoing classes those that were in excess of the preceding decennial average corrected for increase of population were numerically as follows, viz:— Diseases of the Tubercular Class, 13; of the Digestive Organs, 19; Age, 16; Premature birth, 9; Violence, 5; and Urinary Organs, 5: Those that were below such average were Diseases of the Zymotic Class, 7; of the Respiratory Organs, 15; of the Heart, 9; Dropsy, Cancer, &c., 3. The other classes present no noteworthy deviation from their respective averages. The most satisfactory records in the Table are the diminution of the mortality from zymotic diseases and the relative increase of that from longevity. Epidemic diseases, which are included in Class 1, require further notice. 91 Epidemic Diseases, their prevalence and fatality.—The following table exhibits the total number of deaths that were registered as having 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. Diarrhoea. Fever—Typhus and Typhoid. Total Deaths from Epidemic. Total Deaths from all causes. Per centage of deaths from Epidemics to deaths from all causes. 1874 .. 14 2 19 .. 12 6 62 453 11.5 1876 1 2 5 2 14 .. 17 6 46 420 10.9 1876 1 17 12 1 10 .. 16 12 71 461 15.4 1877 • • .. 21 .. 11 .. 16 9 57 384 14.8 1878 .. 4 2 4 6 .. 19 3 38 422 9.0 1879 1 16 16 1 44 .. 7 8 92 516 17.8 1880 .. 9 24 4 16 .. 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 6 11 5 .. 10 12 57 499 11.4 1884. 1 6 5 4 17 .. 27 4 64 576 11.1 The total deaths that resulted from the above diseases were 64 in number, and less by a thirteenth part than the average of the preceding tea years corrected for increase of population ; and the proportion that they bore to the deaths from all causes was upwards of one-third less than such average. Two diseases only of the class exceeded their average fatality; these were Diphtheria and Diarrhoea, the former by one half, the latter by more than a third. Fever was less latal than the average by one half, Measles and Scarlatina by rather less than one-half, while the deaths 92 from Whooping-cough were of average amount. In these calculations the deaths of patients who were removed to institutions situated without the parish are included. The dissemination of infective diseases that results from the return to school of children during convalescence from these diseases claims the serious consideration of the Board, the more so as it admits of a simple and easy remedy long suggested in these Reports (see those for 1859, 1874 and 1882), viz:— "That children absent from School on account of sickness be not allowed to return to school, except upon the production of a certificate from their Medical Attendant that they may do so without risk of conveying infection to others;" to which should be added "That children be not allowed to attend school in whose family there is any infective disease present." A printed certificate embodying the foregoing conditions requiring only the signature of the Medical Attendant is all that is needed for the prevention of what is admittedly a very extensive evil. Such a procedure the School Board Authorities might have been expected to adopt as one of ordinary care and polity. It would also greatly conduce to the benefit ot the public health if a Weekly Return of the names and addresses of all children absent from School on account of infective disease were furnished to the Medical Officer of Health. The months in which the deaths from epidemic diseases occurred with the mean temperature of each quarter of t'.'.e year are exhibited in the following Table:— 93 DISEASE. January February March April May June July August September October November December Mean Temp. 43.4 Mean Temp. 52.5 Mean Temp. 62.7 Mean Temp. 44.1 Small Pox .. .. .. .. .. 1 .. .. .. .. .. .. Measles 1 2 2 .. .. .. .. 1 .. .. .. .. Scarlatina .. .. .. 2 .. .. 2 .. 1 .. .. .. Diphtheria 1 1 .. 1 .. .. 1 .. .. .. .. .. Whooping' Cough 3 5 1 5 1 .. .. .. .. .. 1 1 Diarrhœa 1 .. 1 1 .. .. 5 12 4 2 1 .. Fever .. .. .. .. .. 1 .. .. 2 1 • • .. Totals 6 8 4 9 1 2 8 13 7 3 2 1 18 12 28 6 The mean temperature of the year was 50.7° or 2.1° higher than the average (vide Table 7 Appendix). The temperature of the first quarter, was 4.7°; of the second quarter, 0.2; of the third, 3.0°; and of the fourth quarter, 0.5° above the average. To the high temperature of the summer quarter the excess in the mortality from diarrhoea is attributed in the Annual Summary of the Registrar-General, and for a similar but converse reason it would seem that to the unusually high temperature of the first quarter the great diminution in the fatality from diseases of the Respiratory Organs was most probably due. Deaths in relation to Social Position.—The following Table exhibits the relative proportion ot the total deaths and of the deaths from zymotic diseases amongst the several classes of the inhabitants:— 94 Social Position. Total Deaths. Deaths from Zymotic Diseases. 1884 Decennial Average. 1884 Decennia 1 Average. Nobility and Gentry 3.82 3.62 3.13 0.11 Professional Class, Merchants, Bankers, &c. 5.55 5.33 1.56 6.26 Middle and Trading Classes, Clerks, &c. 24.13 19.93 25.00 19.63 Industrial and Labouring Classes 66.50 71.22 70.31 75.00 100.00 100.00 100.00 100-00 The amount of mortality borne by the labouring classes proportionally to that of the other classes combined, which has shewn a gradual diminution for a considerable number of years, underwent a still further and greater reduction during the past year. This reduction amounted to no less than 4.72 per cent of the total mortality and to 4.69 per cent of the deaths that resulted from zymotic disease, and furnishes very satisfactory evidence of the successful progress of sanitation. Age at death. Infant Mortality;—There was an increase in the mortality of children under 5 years of age, mostly due to a greater fatality from Diarrhoea, the whole of the deaths from that disease having occurred, with three exceptions, to children under that age. The deaths of infants under 1 year of age formed 25 per cent of the total deaths, the average having been 22T per cent; of children under 5 years of age, 37 per cent, the average having been 34.9 per cent; and of all under 20 years of age 41.8 per cent, the average having been 41.5. Calculated from the number of births the death-rate of infants under 1 year of age was 13.4 per cent and corresponded exactly with the average of the preceding ten years. 95 Senile Mortality.—There -was a great increase in the number of deaths at. high ages during the past year. 42 deaths were registered as having resulted from age unassociated with any disease, but 79 deaths, 30 of males and 49 of females were recorded at 70 years and upwards and formed 13.7 per cent of all deaths the decennial average having been 12.0. The deaths of females at high ages, as usual, largely preponderated : thus there were from 70.75, twenty-six deaths, eleven of males and fifteen of females; from 75.80, twenty-five, six of males and nineteen of females; from 80.85, fifteen, seven of males and eight of females; from 85.90 eight, five of males and three of females; at 92, 94, and 96, one female respectively; and at 97, one male and one female. Sickness and Mortality amongst the Parochial Poor.—The nature, amount and fatality of the disease that occurred amongst the parochial poor during the year is contained in Table 5 Appendix, on reference to which it is seen that there came under treatment 581 cases of disease from which 29 deaths or a little under 5 per cent resulted. The total amount of sickness and mortality was 15 per cent less than the preceding decennial averages which represented 678 cases of sickness and 34 deaths, while epidemic disease and its attendant fatality were scarcely half the average amount. This record therefore fully corroborates the figures given in the Table on page 94 shewing the relatively great reduction of the mortality that occurred amongst the labouring classes. The only diseases which can be said to have prevailed epidemically amongst the parochial poor were Scarlatina and Diarrhoea and those only in the Summer quarter. Five isolated cases of Small-pox occurred, 3 in July and 2 in December, and were removed to Hospital where all, except one, recovered, the exception having been a child unprotected by vaccination. Vaccination.—The efficient manner in whichVaccination 96 was carried out during the past year is shewn in a Return made by the Vaccination Officer at the beginning of the present year respecting the vaccination of children whose births were registered during the year 1883; from this it appears that of 915 children born, 801 were successfully vaccinated, 3 were returned as" insusceptible," 55 died unvaccinated, and 11 were postponed on account of sickness, leaving 45 or 4.9 per cent who either could not be found, had removed to places unknown, or were otherwise unaccounted for; the number unaccounted for in the whole Metropolis was 6.6 per cent. Inquests; Violent Deaths; Uncertified Deaths.—Thirtytwo inquests were held during the year. The number is less by seven than that of the year preceding; the deaths from violence were 19 or two more than in the previous year. There were 17 unattested deaths all of which were referred by the Registrar to the Coroner, who decided that a medical investigation of the causc of death was unnecessary. The deceased were, with one exception, all very young infants the oldest of whom did not exceed one year of age, and the assigned causes of death derived from the statements of relatives, neighbours, or nurses—usually the latter—were Bronchitis 1, Brain fever 1, Premature birth 2, Debility 3, and Convulsions 10. The preliminary inquiry by the Coroner implied in the registration of these reputed deaths doubtless prevents the cost and trouble of holding many unnecessary inquests, but inasmuch as his decision as to the necessity or othetwise of holding an enquiry is derived from the hearsay statements of persons unqualified to form a judgment it is submitted that the preliminary investigation ought to be a scientific one and employed in all cases in which the cause of death has not been certified by a Registered Medical Practitioner. (See Reports for 1865 and following on this subject.) 97 A summary of the number and sex of the subjects of inquiry with the verdicts returned is contained in the followiner Table:— Males. Females. Total. Deaths from natural causes 7 6 13 Deaths from violence, viz:— Accidental Suffocation 0 2 Poison 0 1 Run over by train 2 o 9 Drowning 2 0 Fracture 0 1 Injury to spine from a fall 1 0 Suicidal Cut-throat 1 1 3 Strangulation 0 1 Homicidal Suffocation (Wilful Murder) 1 l 2 Poison (no evidence how administered) 1 0 1 Not specified Found dead in riverWandle 3 0 4 Do. do. Thames 1 0 19 13 32 Sanitation.—A greatly increased activity prevailed in all the Sanitary operations of the past year, and in consequence of the anticipated advent of Cholera especially there was a more vigorous prosecution of the measures employed for the rectification of the Sanitary defects of houses and the removal of nuisances generally. On reference to Table 6, Appendix, which contains a summary of the principal of these proceedings, it is seen that the number of house-inspections exceeded those of the preceding year by no less than 1,814. Every house in which contagious disease was found to have occurred was disinfected by Sulphur-fumigation; and in testimony of the thorough efficacy of this method of disinfection—now pursued for several years—it should be noted that in no instance during the past year was there a recurrence of contagious disease after such operation. The large number of 53 pig-nuisances were removed, but not without much cost of time and trouble; and in 5 instances 98 not without the assistance of the law: many of these however will probably recur in consequence of a decision of the sitting magistrate by which a large piggery (ejected from a neighbouring parish) was permitted to be established in the centre of the town. In consequence of the unsatisfactory state of the law and the mode of its administration, there are still some 36 separate piggeries in different parts of the parish containing many of them from 30 to 50 pigs some upwards of 100, and collectively 1000 or more. It is much to be regretted that a sanitary evil ot such extent cannot be more effectually dealt with. Since the year 1812 the keeping of swine within 40 yards of any street or public place has been prohibited in Central London, (Act of George III,cap. 29, sec. 68) and in all reason ought to be as comprehensively disposed of in the suburbs, some of which are equally populous, subject to similar conditions and presenting the same necessity therefore for sanitary provision (see Reports for 1878, 1880 and 1883). All the cow-sheds slaughter-houses, and bakehouses were as usual examined and reported on previous to a renewal of their owners' licenses, and were all found in a satisfactory condition. In common with the other parts of the District strenuous efforts have been made and are being promoted for the purpose presenting a well prepared sanitary defence against the probable advent of Cholera in this Country; and the extensive improvements effected during the past year in the dwellings of the labouring population, with the large number of improved dwellings that have been erected for that class of the community, the systematic house to house inspection and removal of nuisances, justly presuppose the accomplishment of a very great amelioration in the sanitary condition of this Sub-district, the satisfactory state of the health of which has been already recorded in this Report. GEORGE EDWARD NICHOLAS, m.d. Medical Officer of Health for Wandsworth. MAY 28, 1883. 99 APPENDIX OF STATISTICAL TABLES. 100 TABLE I. Births and Deaths registered during the year 1884. BIRTHS. SUB-DISTRICTS. Males. Females. Total. Battersea East—Males, 1360; Females, 1261 2,715 2,560 5,275 West—Males, 1355; Females, 1299 Clapham 596 527 1,123 Putney and Roehampton 182 189 371 Streathara, including Tooting and Balham.. 544 594 1,138 Wandsworth 662 510 1,072 Total 4,599 4,380 8,979 DEATHS. SUB-DISTRICTS. Males. Females. Total. Battersea East—Males, 606; Females, 578 1,288 1,215 2,503 West—Males, 682; Females, 637 Clapham 263 280 543 Putney and Roehampton 105 94 199 Streatham, including Tooting and Balham.. 218 227 445 Wandsworth 284 292 576 Total 2,185 2,108 4,266 * The excess of Births over Deaths in the entire District is 4,713. 101 TABLE II. Summary of Deaths and their Causes, registered in the entire' District during 1884, classified according to Sex, Age, and Social Position, and showing also the relative numbers in each SubDistrict. POPULATION OF ENTIRE DISTRICT. As corrected by the Registrar General. Census 1881—210,434 Official Population for middle of year, 1884, 238,997. Area in Statute Acres, 11,740 Density 20 persous to an acre. Total Deaths from each class of Disease in the entire District. Sub-Districts. Sex. Age. Spcoal Position. Battersea—Popu1ation, 125,091. Area in acres, 2 343. Capham—PopuLation,39,632. Area in acres, 1,233. Putney—Population, 14.450. Area in acres. 2,176. Streatham.Tooting and Balham—Population, 29, 149. Area in acres. 3,465. Wandsworth—Population, 30.*/5. Area in acres, 2,478. Males. Females. Uuder 1 year. From 1 to 5 years. Under 20 years, including all under 10 years. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c Middle & Trading Class, Shopmen, Clerks,&c Industrial and Laboring Class. DISEASES, And other Causes of Death. Classes:— 1. Zymotic. Small Pox 9 5 2 1 ... 1 6 3 ... ... ... 4 3 2 ... ... ... 1 2 6 Measles 182 134 33 1 8 6 106 76 37 136 5 182 ... ... ... ... ... 1 35 146 Scarlatina 47 31 3 ... 8 5 24 23 4 34 6 45 2 ... ... ... ... 4 8 35 Diphtheria 43 18 8 10 3 4 18 25 5 24 10 43 ... ... ... ... ... 8 13 22 Whooping Cough 155 106 15 8 9 17 71 84 83 71 l 155 ... ... ... ... 2 4 30 119 Typhus and other Fevers . 58 46 4 ... 4 4 28 30 1 3 9 27 22 5 . 4 ... 1 1 15 41 Diarrhœa & Choleraic Diseases 239 175 18 8 11 27 126 113 191 35 ... 226 3 4 3 3 4 7 31 197 Erysipelas 28 15 5 ... 2 6 13 15 10 1 ... 12 1 6 8 1 1 ... 3 24 Metria, Childbirth 24 14 2 ... 6 2 ... 24 ... ... ... 2 19 3 ... ... ... 2 5 17 Croup 38 24 5 ... 2 7 24 14 3 30 5 38 ... ... ... ... ... 1 9 28 Other Zymotic Diseases 4 ... ... ... ... 4 4 ... ... ... ... 4 ... ... ... ... ... ... ... 4 Totals of Zymotic Clas 827 568 95 28 53 83 420 407 338 334 36 738 50 20 15 4 8 29 151 639 2. Tubercular 715 479 69 24 58 85 391 324 220 95 17 374 195 132 14 .. 3 22 139 551 3. Of Brain and Nerves 602 298 70 39 67 128 296 306 164 93 15 288 54 112 126 22 27 24 138 413 4. Of the Heart 269 148 53 11 35 22 122 147 10 5 6 39 38 84 99 9 20 15 73 161 5. Of Inspiratory Organs 758 489 97 3 71 70 387 371 225 170 10 416 59 101 158 24 19 22 156 561 6. Of Digestive Organ 227 85 38 12 45 47 109 118 41 14 5 65 24 63 69 6 22 17 65 123 7. Of Urinary Organs 80 34 8 10 13 15 48 32 ... 1 2 4 13 29 33 1 7 17 23 33 8. Of Organs of Geeration 35 16 2 5 9 3 2 33 ... ... ... 2 4 14 14 1 3 7 3 22 9. Of Joints, Bones, &c 24 16 4 2 ... 2 10 14 4 4 1 14 6 1 2 1 1 ... 3 20 10. Of Skin 3 ... 2 ... 1 .. 1 2 3 ... ... 3 ... ... ... ... ... ... 1 2 11. Premaature Birth, Low Vitality, Maiformation, &c. 304 149 47 13 55 40 176 128 304 ... ... 304 ... ... ... ... 2 12 59 231 12. Cancer, Dropsy, and others of Uncertai Seat 148 91 25 5 9 18 60 88 30 3 2 37 17 41 49 4 5 9 38 106 13. Age 154 64 22 7 19 42 63 94 ... ... ... ... ... 2 72 80 18 8 39 89 14. Violence 111 57 11 12 10 21 72 39 28 11 1 51 23 24 8 5 1 2 16 92 15. Not specified 9 9 ... ... ... ... 1 8 ... 6 ... 6 1 ... 2 ... ... 1 3 5 Totals 4266 2503 543 199 445 576 2158 |2108 1367 736 95 2341 484 623 661 157 136 185 897 3048 102 TABLE III. Showing the total number of deaths and their causes registered in the entire District, during the eleven years 1874-84, with the relative numbers of each class of disease. DISEASES, And other causes of Death 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 1884 Classes:— Sinall Pox 5 3 26 57 19 4 3 37 1 .. 9 Measles 66 27 88 64 84 125 59 134 115 133 182 Scarlatina 94 134 86 58 39 134 173 100 119 65 47 Diphtheria 12 28 15 7 19 17 19 18 51 63 43 Whooping Cough 89 107 126 73 149 148 123 105 163 133 145 Typhus and other fevers 48 39 47 64 39 62 44 37 49 52 58 Disease 117 134 159 114 182 94 213 149 117 158 239 Erysipelas 20 24 13 13 5 13 10 15 18 10 28 Metria, Childbirth 34 15 26 20 7 28 23 29 19 25 24 Carbuncle 1 .. .. .. .. .. .. .. 3 .. .. Influenza .. .. .. 1 .. .. .. • • .. .. .. Quinsy 2 .. .. .. 1 .. l .. 1 .. .. Croup 40 26 27 20 39 40 19 18 31 60 38 Totals of Zymotic Class 528 537 613 491 583 665 687 642 687 699 817 2. Tubercular 469 565 555 514 501 513 625 557 521 654 715 3. Of Brain, Nerves, &c. 426 455 316 450 503 474 464 540 539 574 602 4. Of the Heart, &c. 146 176 170 204 212 203 193 245 251 255 269 Of Respiratory Organs 541 630 561 519 694 891 657 695 850 829 758 6. Digestive Organs 111 133 126 155 150 117 155 208 195 234 227 7. Urinary Organs 26 55 62 63 42 74 66 70 89 99 80 8. Of Organs of Generation 21 13 23 29 19 25 20 35 32 30 35 9. Of Joints, Bones, &e. 14 11 14 13 15 8 15 25 25 25 24 10. Of Skin 9 4 5 6 1 3 8 3 9 10 3 11 Premature Birth, Low Vitality, Maiformation, &c. 168 177 226 212 177 170 266 232 234 241 304 12. Dropsy, Cancer, and others of Uncertain Seat 77 105 97 101 106 91 110 118 144 114 148 13. Age 106 130 150 126 141 141 136 120 153 185 154 14. Violence 75 68 90 82 75 83 96 113 104 94 111 15 Not Speoified 79 34 46 26 56 68 95 44 18 40 19 Totals 2796 3096 3154 2991 3275 3526 3593 3647 3851 4083 4266 103 TABLE IV. Showing the total Deaths from the seven principal Epidemic Diseases registered in each Sub-District, and in the entire District, with the relation which they bore to the total Mortality in the several years 1874-84. 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. 1874 238 114 10 26 52 440 2796 15.7 1875 307 4 20 25 46 472 3096 15.2 1876 340 86 19 31 71 547 3154 17.4 1877 280 4 22 25 57 439 2991 14.2 1878 322 103 26 42 38 531 3275 16.9 1879 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 1884 505 83 28 43 64 723 4266 16 9 *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. 104 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, 1884. Compiled from the District Medical Relief Books. SUB - DISTRICTS. Total Cases of Sickness treated in each Sub-District. 1—Small Pox. 2—Measles. 3—Scarlatina and Diphtheria. 4—Whooping Cough. 5—Diarrhoea and Dysentery. 6—Cholera. 7—Fever. 8—Erysipelas. 9—Puerperal Fever. 1 10—Lung Disease 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-Distri.ct Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases 1 Deaths Cases i Deaths Cases Deaths Cases Deaths ' Cises Deaths Cases i Deaths Cases Deaths Cases Deaths Cases Deaths I Cases Deaths Battersea East 725 16 .. 25 .. 10 .. 20 3 12 .. .. .. 14 .. 4 .. .. .. 83 4 15 .. 13 2 512 3 11 .. 12 West 514 23 .. 6 .. 20 .. 5 .. 22 1 .. .. 9 .. 4 .. .. .. 117 4 13 5 19 5 273 5 13 .. 20 Clapham 479 10 9 .. 3 .. 5 .. 44 .. .. .. 36 .. 1 .. 9 • • 115 10 4 1 6 3 194 10 18 1 25 Putney and Roehampton 111 .. .. .. .. .. 3 .. 13 1 1 .. .. .. 1 .. .. .. 16 1 6 .. .. .. 71 4 1 •• 6 Streatham including Tooting and Balham 227 1 .. 8 .. 14 .. 1 .. 11 .. .. .. 1 .. 1 .. 1 1 25 1 2 .. 2 .. 161 1 .. .. 3 Wandsworth 581 5 .. 3 •• 7 2 1 25 1 •• .. 2 •• 4 .. .. .. 122 8 9 7 4 2 359 9 39 1 29 Totals 2637 56 .. 51 .. 54 .. 36 4 27 3 .. .. 52 •• 15 •• 10 1 478 28 49 13 24 12 1570 32 82 2 93 * The ratio of deaths in cases treated is 3.6 per cent. 105 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1884. Battersea. Clapham. Putney and lloehampton. Streatham, including Tooting & Balham. Wandsworth. Totals. N umber of Houses & Premises inspected 1 497 2270 2336 4944 4653 27700 1st Notices served 1660 554 422 297 539 3872 2nd Notices served 69 373 21 36 50 549 Number of Houses disinfected after contagious diseases 185 44 28 31 69 358 Number of Houses in which contagious disease occurred after disinfection .. 3 .. (rooms 63) .. 3 Number of Houses from which bedding, &c. was burnt 6 21 .. 5 2 33 Overcrowding abated 15 12 3 3 4 37 Disinfecting apparatus at Putney number of times used .. .. 26 .. .. 26 Cesspools emptied & cleansed .. .. 4 4 2 10 Cesspools abolished 1 5 2 9 •I 19 Waterclosets constructed or repaired 420 361 50 211 212 1260 Houses supplied with water 28 2 5 8 2 35 Drains constructed or connected with Sewer 277 131 31 .. 138 577 No. of feet of New Sewers and Branch Drains 10370 3722 5746 .. 19750 39588 Drains repaired or trapped, or obstructions removed 630 721 92 216 38 1697 Open Ditches, Ponds, &c. cleansed .. .. 2 13 15 Dust-bins provided 337 94 87 130 510 1158 Leaky House-roofs & Gutters repaired 60 137 .. .. .. 190 Water-cisterns covered & rep'd 179 671 .. .. .. 757 Yards drained and paved .. 240 , , , . 240 Pig Nuisances removed 15 9 2 9 53 88 Accumulation of Offal, Manure &c. removed 29 29 8 62 21 149 Unwholesome and dilapidated Houses cleansed or repaired 316 380 8 33 12 749 Cases investigated by Magistrates 14 21 5 3 5 48 Compulsory Orders obtained 13 18 3 2 33 Compulsory Works executed 13 17 .. .. 2 32 Works remaining in abeyancc from various causes •• 1 .. .. •• 1 106 TABLE VII. METEOROLOGICAL TABLE FOR LONDON, 1884. 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 Elastic Force of Vapour. "Weight of Vapour in a Cubic Foot of Air. Degree of Humidity. Reading of Barometer. Weight of a Cubic Foot of Air. Rain. Reading of Thermometer on Grass Air. Evaporation. Dew Point. Air— Daily Range. Number of Nights it was Lowest Reading at Night. Highest Reading at Night. Mean. Diff. from Average of 113 Years. DifP. from Average of 43 Yea re. Mean. Diff. from Average of 43 Years. Mean. Diff. from Average of 43 Years. Mean. Diff. from Average of 43 Years. Mean. Diff. from Average of 43 Years. Mean. Diff. from Average of 43 Years. Mean (Satn=100). Diff. from Average of 43 Years. Mean. Diff. from Average of 43 Years. Mean. Diff. from Average of 43 Years. Amount. Diff. from Average of 70 Years. At or below 30°. Between 30° & 40°. Above 40°. 1884. 0 o o o o o o o o in. in. grs. gr. in. in. grs. grs. Sums. Sums. 1 0 o in. m. YEAR. 50.7 +2.1 + 1.3 47.6 + 1.0 44.4 +0.7 16.1 +0.2 .301 + .007 3.4 0.0 80 —3 29.813 + .027 541 —2 18.05 -7.33 65 177 124 17.5 58.4 First Quarter 43.4 +4.7 + 3.5 41.3 +3.3 38.8 +3.4 11.6 —0.3 .237 + .031 2.7 + 0.3 84 -1 29.807 + .043 549 -4 4.64 —0.37 22 59 10 24.0 42.0 Second do. 52.5 +0.2 —0.4 48.8 -0.3 45.1 —0.4 19.8 —0.2 .304 —.003 3.5 0.0 76 —2 29.775 —.003 538 —1 4.31 —1.50 12 50 29 17.9 50.8 Third do. 62.7 +3.0 + 2.5 58.2 + 1.8 54.0 +0.9 21.6 + 1.9 .417 + .012 4.6 0.0 74 —4 29.817 + .025 527 —3 4.53 —2.87 0 18 74 30.7 58.4 Fourth do. 44.1 +0.5 —0.4 42.1 —0.6 39.7 —0.9 11.4 —0.4 .246 —.013 2.8 —0.3 85 —3 29.854 + .043 549 + 2 4.57 —2.59 31 50 11 17.5 46.7 III this Table, + and — respectively signify that the numbar in the preceding column are above or below the average to the extent of the quantities to which these signs are prefixed.