WAN 36 THE Board of Works for the Wandworth District. SANITARY DEPARTMENT. REPORT on the SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE Wondsworth District, DURING THE YEAR 1885. BY THE MEDICAL OFFICERS OF HEALTH AND THE ANALYST. London: ashfleld, STEAM PRINTER, BRIDGE ROAD WEST, BATTERSEA, 1886. To the Board of Works for the Wandsworth District. GENTLEMEN, We have the honour to present our Report for the year 1885 on the vital statistics and sanitary condition of the Wandsworth District. In this, the 30th Annual Report presented to your Board, we have followed the general arrangement of matter adopted in previous years. It is hoped, however, that the additional matter which will be found in the following pages will enhance the value and interest of the report. These additional matters are, in particular, Dr. Muter's Analytical Report, the returns of patients in the Asylums Board Hospitals, the returns of Deaths in outlying Institutions, and the Death.rate at various age. groups in the census year. We have to congratulate you on a lower rate of mortality than in any of the ten preceding years, and to assure you that no efforts will be lacking on the part of the officers of the Safritary Department to ensure a continuance of this low mortality, especially from those diseases which are known to be most amenable to sanitary precautions. We have the honour to remain, Gentlemen, Your obedient Servants, The Associated Medical Officers of the Wandsworth District. May 24th, 1886. INDEX. Page. Introductory Report on the Health of the Entire District 5 Dr. Kempster's Report for East Battersea 28 ,, Oafcman's „ West ,, 43 Newsholme's ,, Clapham 55 ,, Walker's ,, Putney . 68 „ Sutton's ,, Streatham 79 „ Nicholas' Wandsworth 91 ,, Muter's Analyst's Report 109 Appendix of Statistical Tables 112—116 SPECIAL POINTS RAISED IN THE LOCAL REPORTS. New Table of Death.rates at different ages 17 Infantile Mortality in each sub.district 18 A more frequent census required 92 Number of Patients in Asylums Board Hospitals 13 Use of Outlying Institutions by each sub.district 10 Urgent necessity for a constant Water Supply 22 Dangers of Wells in Towns 109 Ventilation of Drains 39 Defective legislative power to remedy Sanitary Defects 77 Important Definition of Nuisance by Mr. Justice Cave 89 Diarrhoea in relation to temperature and rainfall 21 Small.Pox in relation to Vaccination 15, 33 Steady Diminution of Scarlet Fever in London 63 Relation of EntericFever and Diphtheria to DefectiveDrainage 34, 64 Proposed relegation of control of Cowhouses and Dairies to Local Authority 67 Disinfection after Measles and Whooping Cough 105 REPORT, ON THE HEALTH AND SANITARY CONDITION OF THE ENTIRE DISTRICT, 1885. VITAL STATISTICS. The number of persons living in this District population. at the middle of the year 1885, assuming the rate of increase of the population to be the same as during the decade 1871—81, was 248,410, being an increase of 9,413 on the previous year's population. The total births registered during the year births. numbered 8,606,—4,365 of males and 4,241 of females.The number of births and the birth.rates in the several sub.districts are compared in the following table:— 6 TABLE A. BERTHS. RATES. Sub.Distbicts. Males. Females. Total. Birthrate. Rate of Natural Increase. Battersea East west 1301 1195 2496 37.4 21.2 1288 1270 2558 39.8 20.2 Clapham 511 519 1030 25.2 12.7 Putney 169 153 322 21.7 10.4 Streatham 525 553 1078 35.9 22.1 Wandsworth 571 551 1122 37.3 18.5 Whole District 4365 4241 8606 34.6 17.9 The birth.rate, calculated from the total births Birth.rate. registered and the foregoing estimated population, was 34.60 per 1,000 persons living. The Rate of Natural rate of natural increase, represented by the excess increase, of births over deaths, was 17.9 per 1,000. The total deaths registered during the year Deaths. numbered 4,192,—2,068 of males and 2,124 of females. The number of deaths and the death.rates of the several sub.districts are compared in the following table:— TABLE B. DEATHS. death-rate. Sub.Districts. Males. Females. Total. Battersea East West 545 526 1071 16.0 666 729 1395 17.5 Clapham 237 271 508 12.4 Putney 93 74 167 11.2 Streatham 197 226 423 14.0 Wandsworth 330 298 628 17.0 Whole District 2068 2124 4192 16.8 7 Death. The death.rate was 16.87 per 1,000 persons, rate. a lower rate than in any of the ten preceding years. The birth.rates, death.rates, and rates of natural increase of the past and ten previous years are shewn in the following table:— TABLE C. Birth.rates, Death.rates, and rates of Natural Increase in the entire district during the ten years 1875—84, compared with those of the year 1885. Years. Births. Birth.rate per 1000. Deaths. Death.rate per 1000. Natural Increase. Rate of Natural Increase per 1000. 1875 5529 37.30 3096 20.87 2433 16.40 1876 5999 39.04 3154 20.00 2845 18.51 1877 6159 38.60 2991 18.70 3168 20.00 1878 6508 39.40 3275 19.80 3233 19.80 1879 6833 39.70 3526 20.50 3307 19.23 1880 7038 34.20 3593 17.50 3445 16.80 1881 7582 35.68 3647 17.16 3935 18.51 1882 7889 35.69 3851 17.42 4038 18.26 1883 8079 35.14 4083 17.79 3996 17.39 1884 8979 37.57 4266 17.85 4713 19.77 Mean of Ten Years 1875—84 7059 36.53 3548 18.75 3041 18.46 1885 8606 34.60 4192 16.87 4414 17.9 8 It will be seen from this table that the death.rate is 1.88 per 1,000 less than the decennial average. It is also 3.63 per 1,000 less than the rate for the 28 great towns, and 2.83 per 1,000 less than that for the whole of the Metropolis. The following shews at a glance the great diminution in the mortality of this District since the year 1851, notwithstanding the fact that the density of population has been, especially during 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 17.79 ,, ,, 1884 17.85 ,, ,,1885 16.87 Deathsin outlying institutions The deaths already enumerated do not include those of inhabitants of this District who have died in the various hospitals and other institutions without the District. Doubtless the lower mortality caused by the occurrence of these deaths apart from the population to which they rightly belong is to some extent counterbalanced by the death of temporary immigrants into the Wan Isworth District from the country, and by the deaths occurring in the 9 public institutions of West Battersea and WandsWorth. But a true estimate of the mortality of the Wandsworth District should include the deaths of its inhabitants which occur in external institutions, as shown in the following table:— TABLE D. Deaths in Outlying Institutions. CAUSES OF DEATH. Number in Entire District. East Battercea. West Battersea. Clapham. Putney. Streatham. Wandsworth. Union Infirmary. General and Special Hospitals. Asylums Board Hospitals. Small Pox 31 15 6 4 l 2 3 • • .. 31 Scarlet Fever 2 .. 1 . . 1 .. .. .. .. 2 Diphtheria 10 7 .. 2 l .. .. .. 10 .. Enteric Fever 8 3 2 2 .. .. 1 .. 3 3 Whooping Cough 1 .. .. .. .. .. 1 1 • • • • Measles .. .. .. .. .. .. .. .. .. .. Other Zymotic Diseases 9 6 .. 2 .. .. 1 4 4 1 Tubercular Diseases 64 27 10 9 5 2 11 23 40 1 Cancer 31 13 2 5 2 4 5 11 20 .. Rheumatism 2 1 .. .. .. .. 1 . . 2 .. Respiratory Diseases 63 22 9 6 4 3 19 30 33 . . Circulatory Diseases 55 18 10 14 4 3 6 27 26 2 Nervous Diseases 65 18 7 15 6 8 11 41 22 2 Other Diseases 107 35 18 17 5 15 17 43 60 4 Violence 21 14 3 1 .. 1 2 .. 21 .. 469 179 68 77 29 38 78 180 241 48 It will be seen that 469 deaths occurred in outlying institutions, of which 180 were in the Union Infirmary, 241 in the general and special Hospitals of the Metropolis, 10 and 48 in the Asylums Board Hospitals. The addition of these 469 deaths to the 4,192 within the District raises the death.rate to 18.7 per 1,000, as compared with 19.6 in the previous year. It is interesting to note in what proportion to its population each sub.district made use of these outlying institutions for its sick, so far as this can be inferred from the number of deaths. Use of outlying In East Battersea, 2.68 per 1,000 of the institutions population died in outlying institutions; in by each West Battersea, 2.23 per 1,000 (in this sub district. stnce the 76 deaths of inhabitants of West Battersea which occurred in the Union Infirmary within its borders have been included, in order to make the rate comparable with that of the other sub.districts); in Clapham, 1.88 per 1,000; in Putney, 2.01 per 1,000; in Streatham, 1.25 per 1,000; and in Wandsworth, 2.47 per 1,000. The following table is well worthy of study as bringing out some further details in connection with the mortality of the Wandsworth District. It gives the death.rate of the several sub.districts, inclusive and exclusive of the deaths in outlying institutions, shewing also the amount and density of population, and the proportional number of the industrial classes which each sub.district possesses: — 11 TABLE E. SUB.DISTRICTS. Population in the middle of 1885. Percentage of Total Population. Density of Population— Number of Persons to an Acre. Relative Number per cent, of Industrial and other Classes. Death.rate per 1,000, including deaths in Public Institutions in Sub.district. Death.rate per 1,000, excluding deaths in Public Institutions, within and without the Sub.district. Death.rate per 1,000, including deaths in Outlying Institutions, excluding deaths in Public Institutions within the Sub.district. Industrial Classes. Other Classes. East Battersea 66,654 26.83 55.9 86.1 13.9 16.0 16.0 18.7 West Battersea 64,317 25.89 86.3 13.7 21.6 17.5 19.8* Clapham 40,832 16.43 33.1 45.9 54.1 12.4 12.4 14.3 Putney 14,830 5.97 6.8 55.7 44.3 11.2 11.2 13.2 Streatham 30,280 12.18 8.7 48.22 51.78 14.0 14.0 15.2 Wandsworth 31,497 12.70 12.7 67.2 32.8 19.9 17.0 18.8 * In estimating this rate, the deaths in Union Infirmary which belonged to West Battersea (76 in number) are included, in order that the rate may be comparable with that of the other sub.districts. 12 The density of the population in Battersea has increased during last year twice as much as that in any of the other sub.districts, and it is gratifying to find that there has been no corresponding increase of its mortality. Mortality and Zymotic diseases caused 15.2 percent. of its Causes. the total deaths in the district as compared Zymotic Diseases with 19.1 percent, in the previous year. The zymotic death.rate was 2.56 per thousand of the population; the largest proportion of the deaths from zymotic diseases resulting from the seven chief epidemic diseases enumerated in the following table. TABLE F. Whole District. East Batteisea. West Battersea. Clapham. Putney. Streatham. Wandsworth. Small.pox 5 1 1 .. .. .. 3 Measles 140 49 63 3 4 2 19 Scarlet Fever 11 3 5 .. .. . . 3 Diphtheria 28 8 2 4 3 5 6 Enteric Fever 40 8 9 8 5 6 4 Whooping.cough 178 47 74 25 1 7 24 Epidemic Diarrhoea 193 63 63 16 4 12 35 Other Zymotic Diseases 42 14 17 5 1 2 3 Total Deaths from Zymotic Diseases 637 193 234 61 18 34 97 Zymotic Death. rate 2.56 2.8 3.6 1.4 1.2 1.1 3.0 Death.rate from all Diseases 16.8 16.0 17.5* 12.4 11.2 14.0 17.0* * Excluding deaths in Public Institutions, 18 If to the 637 deaths from zymotic diseases be added the 61 deaths from the same diseases in Out.lying Institutions of inhabitants of this district, the zymotic death.rate becomes 2.8 per thousand of population. Table D (page 9) shews that 31 deaths of inhabitants of this district from Small.pox occurred in the Asylums Board Hospitals, while only 5 occurred at their own homes. Epidemic Diarrhoea was the most fatal zymotic disease, Whooping.cough and Measles coming next in fatality; Enteric Fever caused 40 deaths within the district and 10 without; Diphtheria 28 within and 10 without; while Scarlet Fever only caused 13 deaths altogether. The local incidence of the mortality from the seven chief epidemic diseases can be best understood by a comparative study of Tables D and F. Asylmns The above figures only give the mortality Board hospitals. from the various epidemic diseases. The weekly returns now sent by the Asylmns Board to each Metropolitan Medical Officer of Health enable us to give in the following table the number of patients admitted into these hospitals from the various sub.districts of the Wandsworth District, as well as from the rest of the Metropolis, and the proportion in each case to the population. These returns date from 23rd January, 1885, to the end of the year. 14 TABLE G. Number of cases of Infectious Diseases admitted into the Metropolitan Asylums Board Hospitals from 23rd January to 31 st December, 1885. Small.pox. Proportion to Population. Scarlet Fever. Proportion to Population. Enteric Fever. Proportion to Population. Typhus Fever Proportion to Population. Battersea 153 .. 17 .. 7 .. 1 .. Clapham 21 . . 18 .. 1 .. 0 . . Putney 4 .. 0 .. 1 .. 0 . . Streatham 20 .. 5 .. 0 . . 0 .. Wandsworth 25 .. 16 .. 3 .. 0 .. Entire Wands. worth District 223 1 in 1109 561 1 in 4435 12 1 in 20700 1 1 in 248410 Rest of Metropolis 4837 1 in 792 10461 1 in 3666 136 1 in 28128 42 1 in 91321 Whole Metropolis 5060 .. 1102 .. 148 .. 43 .. Vaccination. The delays in vaccination and in making out returns render it necessary as in previous years to give the Vaccination returns for a year previous to that dealt with in the other statistics of this Report. The following table gives a concise view of the work in Vaccination, carried out during the year 1884. TABLE H. SUB. DISTRICTS. Number of Births Returned from 1st. January to 31st December, 1884. Successfully Vaccinated. Insusceptible of Vaccination. Had Small.pox. Dead Unvaccinated. Postponed by Medical Certificate. Removed to Districts Vaccination Officer of which has been duly apprised. Removed to places unknown, or which cannot be reached; and cases not having been found. East Battersea 2597 2083 8 .. 273 27 2 204 West Battersea 2604 2171 1 .. 209 27 4 192 Clapham 1108 922 3 1 114 24 5 39 Putney 364 310 1 .. 33 3 1 14 Streatham 1129 903 5 .. 94 20 18 87 Wandsworth 1063 939 3 .. 67 3 .. 50 Totals 8865 7328 21 1 790 104 30 586 15 Out of 8,865 children, 7,328 were successfully vaccinated, and the remainder were accounted for by death, insusceptibility to vaccination or postponement on account of illness; except 582, i.e. 6.6 percent. In the previous year 7.5 percent, were unaccounted for. The great prevalence of Small.pox in the Metropolis during the last year is doubtless ascribable to the accumulation of this large percentage of unprotected persons; and to the fact that we have no compulsory notification of cases, followed by isolation of patients and quarantine of those who have been exposed to infection,— which has served hitherto, as in Leicester, to shelter from infection persons unprotected by vaccination. Non.Zymotic In Table I. in the Appendix, the number Diseases. of deaths from the various constitutional and local diseases are given, and in Table II. these are compared with the corresponding deaths of the ten previous years. Deaths at The deaths of children under 5 years of different ages. age amounted to 46.4 percent, of the total deaths, as compared with 49.2 percent, in the previous year. At the other extreme of life, i.e. at 60 years of age and upwards, 21.2 percent, of the total deaths occurred, as compared with 19.2 percent, in the previous year. In the following table the number of deaths at various group.ages is given, and compared with the corresponding number in the ten preceding years. 16 TA BLE I. AGE. YEARS. Under 1 year. From 1 to 5 years. From 5 to 10 years. All under 20 years. From 20 to 40 year8. From 40 to 60 years. From 60 to 80 years. 80 years & upwards. 1874 177 452 107 1838 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 948 682 102 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 1885 1268 660 94 2153 467 683 740 150 The preceding statements however do not evade the fallacy contained in the fact that the number of people living at different groups of ages may increase or diminish, in which case the death.rate would similarly oscillate. Thus an increase in the relative number of children under 5 years would increase the entire death. rate, as children of this age have a higher mortality than older persons. Similarly the presence in any sub.district of an excess of persons between 15 and 35 (ages of low mortality), as for instance where there is a large number of domestic servants,—would lower its apparent death. rate. Death.rates This fallacy is escaped in the following at different ages table. It unfortunately refers to the year 1881, the absence of annual census returns preventing the application of the method to the deaths of the present year. The table is however inserted as an example of an important method, and as a datum for comparison when the results of the 1891 census are known. 17 TABLE J. Shewing Census Population of 1881 at different groups of ages: male and female death.rates, and death.rates at different groups of ages: the different parts of the Wandsworth District being compared throughout. SUB. DISTEICTS. ALL AGES. No. of persons under 5 years. Death.rate under 5 years. No. of persons aged 5 to 10 years. Death.rate 5 to 10 years. Persons 10 to 20 years. Death.rate 10 to 20 years Persons 20 to 40 years. Death.rate 20 to 40 years. Persons 40 to 60 years. Death.rate 40 to 60 years. Persons 60 to 80 years. Death.rate 60 to 80 years. Persons 80 years old and upwards. Death.rate over 80 years. No. of Persons. General Death.rate per 1,000 of Population. No. of Males. Male Death.rate. No. of Females. Female Death.rate. Battersea 107262 20.1 52665 20. 08 54597 19.51 17283 63.0 14763 5.01 21194 3.44 32960 6.88 16378 18.6 4228 72.4 255 270.5 Clapham 36380 13.7 15935 13.18 20445 14.13 4407 45.6 3801 7.10 7586 3.42 12020 407 6138 11.2 2259 43.3 169 171.6 Putney 13235 12.6 5406 17.01 7829 9.58 1470 46.9 1289 6.20 2680 1.86 4878 5.33 2088 7.66 768 41.6 62 177.7 Streatham 25553 12.2 10825 13.85 14728 11.06 3206 36.4 2631 3.04 5102 2.74 8879 4.95 4103 10.4 1529 43.1 103 203.8 Wandsworth 28004 18.1 13328 19.05 14676 17.23 3527 54.1 3045 4.92 5697 3.51 9049 7.07 4899 23.0 1684 48.6 103 213.5 *Tlie death.rates are in all cases per 1,000 of the people living at the special age.group under consideration. 18 The true mortality among children Infantile Mortality. under one year ot age can only correctly be stated in terms of the number living at that age, obtained from the birth returns. The death. rate of infants under one year per 1,000 births was as follows in the various sub.districts. In East Battersea 154 deaths under 1 yr. per 1,000 births ,, West ,, 175 ,, ,, ,, Clapham 120 ,, „ „ Putney 133 „ „ ,, Streatham 110 ,, ,, „ Wandsworth 132 „ ,, Social Position of In the following table the relative Deceased. proportion percent of the mortality borne by the several classes of the inhabitants during the years 1878.84 is compared with that of the past year. TABLE K. Social Status. 1878 1879 1880 1881 1882 1883 1884 1885 Nobility & Gentry 1.62 3.30 3.40 2.71 3.43 2.48 4.41 2.76 Professional Class 5.08 5.90 5.50 5.12 4.44 5.66 6.25 4.67 Middle Class 18.10 17.40 16.90 19.00 20.85 19.59 25.66 19.10 Industrial Class 75.20 73.40 74.20 73.17 71.28 72.27 63.68 73.47 100.0 100.0 100.0 100.00 100.00 100.00 100.00 100.00 inquests. The inquests held during the year Deaths by violence. were 174, or 4 less than in the previous year, and formed 4.2 percent of the total deaths. 19 The whole of the deaths which formed the subject of a Coroner's inquiry in the several sub-districts are classified according to the verdicts in the following table. TABLE L. Sub.Districts. Verdicts. Total. Battersea Clapham Putney Streatham WaDdsworth East West Deaths from Natural Causes 78 14 30 9 4 3 18 Deaths from Violence .. .. .. .. .. .. .. Accidental Drowning 9 3 2 .. 1 .. 3 Suffocation 28 16 6 .. .. 1 4 Railway Injuries 8 2 2 .. .. 3 1 Scalds and Burns 4 1 3 .. .. .. .. Poisoning 4 1 1 .. .. 2 .. Concussion, Fracture, &c. 5 5 .. .. .. .. .. Injuries from Fall 7 .. 3 .. .. .. .. Other Injuries 7 1 3 .. .. .. 3 Suicidal: Poisoning 2 .. 1 .. .. .. .. Hanging 4 .. . . .. .. .. .. Shooting 2 .. .. .. .. 1 .. Drowning 3 .. 1 .. .. 1 1 Cut-Throat 3 .. .. 1 .. .. 2 Homicidal: Cut.Throat 1 .. .. l .. .. .. Fractured Skull from being knocked down 1 .. .. .. .. 1 .. Manslaughter 1 .. .. .. .. • • 1 Execution 1 .. .. .. .. .. 1 Open Verdicts Fonnd Drowned 4 .. 2 2 .. .. .. Found Dead 2 .. 1 •• .. • • 1 174 45 55 19 8 12 35 20 A reference to the table shows that of the total number 78 were due to natural causes and 96 to violence. Of the latter 72 were accidental, 14 were suicidal, 4 homicidal, and in 6 open verdicts were returned. The number of deaths in which the Uncertified Deaths. cause was not certified by medical testimony, but in which the Coroner did not deem an inquest necessary, was 58; as compared with 72 in 1884 and 48 in 1883. Of the 58, 19 occurred in East Battersea; 17 in West Battersea, 14 in Streatham, 8 in Wandsworth, and none in Putney or Clapham. The nature, amount, and fatality of Sickness & Mortality among the sickness that occurred among the Parochial Poor. parochial poor in the ^ several subdistricts are set forth in Table III. (Appendix, page 114), which forms a valuable index of the sickness occurring in the District generally. The total number of cases coming under treatment was 3218, as compared with 2637 in the previous year. The proportion of deaths to cases under treatment was only 3.7 percent, being 1.3 less than in 1884. Meteorology A reference to Table V. in Appendix of the Year. will shew the general characters of the climate during 1885. The rainfall was somewhat below the average, as was likewise the mean temperature. In the following table the number of weekly deaths from Diarrhoea in the whole Metropolis are compared with the mean weekly temperature and rainfall, during the weeks in which Diarrhoea was most prevalent, in order to bring out the relationship between the prevalence of this disease, and a high mean temperature and deficient rainfall, 21 TABLE M. Week of the Year. Deaths from Diarrhoea in whole Metropolis. Mean Temperature of Air in Degrees Fahrenheit. Fall of Rain in inches. 20th 16 48.4 0.74 21st 20 56.0 0.46 22nd 11 62.6 0.27 23rd 23 58.5 0.90 24th 24 58.7 0.39 25th 44 58.3 0.11 26th 51 60.5 0.00 27 th 110 65.0 0.02 28th 209 61.2 0.49 29th 284 64.5 0.01 30th 348 65.2 0.01 31st 309 59.4 0.46 32nd 222 58.2 0.14 33rd 163 57.6 0.61 34th 121 57.2 0.40 35th 83 56.3 1.93 36th 62 57.7 0.86 37th 40 52.7 0.18 38th 49 49.6 0.52 39th 42 47.6 1.09 40th 35 45.4 0.44 The relationship between a high atmospheric temperature and Diarrhoea is probably through the rapid production of fermentative and putrefactive changes. In hot weather, the food of hand-fed children rapidly decomposes and the feeding-bottles are sour. Milk is particularly prone to decomposition under the same conditions, and should therefore always be scalded. Water is liable (when it contains the least trace of impurities) to take on similar changes, and should therefore be always boiled before use. A defective rainfall may act through the defective flushing of sewers and 22 house drains which results; and through the dusty condition of the streets, the dust carrying with it a considerable portion of organic matter. This district being entirely supplied Water Supply. from the Thames, suffers from the disadvantages of river-water as a source of drinking-water. One of the chief of these is its extremes of temperature (varying from 37o.0 to 70o.5 Fahr. during the year, as compared with a variation between 530.6 and 580.l Fahr. in the deep-well water distributed by the Kent Company). The deep-well water remains refreshing and palatable in the summer, while in winter it diminishes the risk of frozen pipes, in both of which respects it is very superior to river-water. Deep-well water again has been subjected to natural filtration through deep strata, the efficiency of which cannot be equalled by artificial filtration. Little complaint need, however, be made of the Company's water, if it were always drunk in as comparatively pure condition as contained in the mains. A Constant Supply While in the cistern, which usually required. supplies the closet with flushing-water and the inmates of the house with drinking-water, it is open to frequent contaminations, owing to the absence or defective condition of lids; or to accidental emptying of the cistern and then absorption of foul gases from the closet-pan; or to the connection of the overflow-pipe with some part of the drainage system (still not an uncommon condition); or to other causes. The tepiJ condition of the water induced by exposure to a hot sun in a shallow cistern, gives rise to putrefactive changes, which are active in the production of Summer Diarrhoea. A constant supply of water, which would 23 abolish the cistern except for flushing water-closets, is one of the most urgent sanitary reforms in the immediate future, and we beg to call your earnest and continued attention to it. Sanitary Operations A study of Table IV. in the Appendix of the Year will give a clearer understanding of the detailed sanitary work carried out in each subdistrict than any verbal description. The attention paid to defects of house-drainage is steadily increasing, and there can be no doubt that the action taken by the Board through its officers, is having an influential educative effect on builders, plumbers, and others concerned in house.construction and drainage. Abundant powers exist for the enforcement of all items detailed in Table IV., though it is highly satisfactory that in so few instances it has been necessary to appeal to the slow and cumbrous machinery of the law. LOCAL SUMMARIES. 27 B AT T E R S E A. The official mean population for the whole Parish for the year 1885 was 130,971. The births registered during the year were 5,054, and the birth-rate was 38.58 per thousand. The birthrate for London was 32.6 per thousand. The deaths recorded were 2,466, which would give a resulting death-rate of 18.08 per thousand, but if the deaths of 124 non-parishioners in the Union Infirmary are deducted, the death-rate would be equal to 17.88 per thousand, the Metropolitan mortality for the year being 19.7 per thousand. 28 EAST BATTEBSEA. An essential preliminary in a report relating to the sanitary condition of the sub-district is to estimate the population upon which the various rates are to be calculated. During the latter years of the last decade, 1871—81, this was a matter of some difficulty to determine, as the official population employed by the Registrar General was much smaller than the estimated population deduced from the number of births, thus unduly over estimating both the birth and death rates. The census proved the almost absolute correctness of the estimated population. It is however not probable that descrepancies so great can again occur, and it may be readily demonstrated that the numbers now arrived at by both the methods give almost identical results. The population of the sub-distrirt by the official method of computation for the year 1885 was 66,654, being 2,948 more than that of the preceding year, a not excessive estimate of increase, the natural increase by the surplus of births over deaths being 1,415, as is shewn in Table I., the latter being equal to a rate of 21.2 per thousand. TABLE I. Birth and Death Rates. YEARS. Births. Birth-rate. Deaths from all Causes. Death-rate. Natural Increase. 1876 1,968 42.0 893 19.0 1.075 1877 1,972 42.0 905 19.25 1,067 1878 2,185 42.0 895 17.8 1,290 1879 2,344 42.0 978 17 .5 1,366 1880 2,267 41.57 1,030 18 .9 1,127 1881 2,349 41.1 966 16.8 1,383 1882 2,352 39.13 992 16.48 1,360 1883 2,383 39.22 1,003 16.5 1,380 1884 2,621 41.14 1.184 18.5 1.437 1885 2,496 37.4 1,071 16.0 1,425 N.B.—The birth and death rates for 1876—9 are based upon the estimated mean population, the correctness of which was proved by the census of 1881, 29 This table will be found useful as contrasting the birth and death rates for the last ten years. For the years 1876-7-8-9 the estimated (not the official) rates have been given, which former the census returns shewed to have been almost absolutely correct. The birth-rate for those years was estimated at 42 per thousand. The official birth-rate for those years was 53.8; 51.4; 58.0, and 56.0 per thousand, obviously excessive and incorrect. The rates which time has pioved to be the correct ones are therefore given. For similar reasons the actual natural increase of population by excess of births over deaths is here shewn instead of the rate of increase per thousand. Births. The births registered during 52 weeks comprised in the year 1885 were 2496. The males registered were 1,301 in number, and the females 1,195. The consequent birth-rate would be 37.4 per thousand per annum, the lowest birth-rate yet recorded for East Battersea and shewing an approximation to the rate for the Metropolis at large, which was 32.6, the lowest recorded with one exception. It may be anticipated that in a few years the birth-rate in the sub-district will be identical with that for London as a whole, it having fallen 5 per thousand per annum duriug the last five years. Mortality. During 1885 the deaths of 1,071 persons were registered. Of these 545 were males and 526 were females. Upon the official mean population of 66,654 the death rate was 16 per thousand during the year. This is the lowest rate of mortality which it has been my province to record and contrasts favourably with the Metropolitan mortality of 19.7 per thousand. 30 TABLE II. Statistics of Mortality. EAST BATTEREA. Total Deaths from each class of Disease, &c., in the Sub-district. Sex. Age. Social Position. Population (Census) 1881 54,675 Official Population in middle of 1885, 66,654 Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. From 10 to 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. CAUSES OF DEATH. I. Zymotic. Small-pox 1 .. 1 .. .. .. 1 .. .. .. .. .. .. .. 1 Measles 49 23 26 4 39 6 .. .. .. .. .. .. .. 3 46 Scarlet Fever 3 3 .. .. .. .. ... .. .. .. .. .. .. 1 2 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 9 6 3 .. 3 .. 4 2 .. .. .. .. .. 3 6 Puerperal Fever 8 8 .. .. .. 1 7 .. .. .. .. .. 1 7 Diphtheria 8 2 6 .. 6 1 .. .. .. .. .. .. 1 1 6 Whooping Cough 47 26 21 20 24 2 1 .. .. .. .. .. 1 2 44 Erysipelas 5 4 1 1 .. .. .. .. 2 .. .. .. .. 1 4 Diarrhoea, Dysentery, and Cholera 63 33 30 54 4 .. 2 1 1 1 .. .. 1 7 55 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. II. Constitutional. Totals of Zymotic Class 193 97 96 80 79 9 9 10 3 3 .. .. .. 19 171 Gout and Rheumatism 11 4 7 .. .. .. 1 3 1 6 .. .. 1 3 7 Cancer & other Tumours 18 6 12 . .. .. .. 2 7 8 1 1 1 1 15 Other Constitutional Diseases 7 7 .. 7 .. .. .. .. .. .. .. .. .. .. 7 Tubercular Phthisis 91 33 58 3 .. 5 13 30 38 2 .. .. 3 11 77 Tabes Mesa 62 38 24 53 7 .. 1 .. 1 .. .. .. 1 3 58 Hydrocephalus 27 12 15 10 15 2 .. .. .. .. .. .. 2 1 24 Scrofula 1 .. 1 .. 1 .. .. .. .. .. .. .. .. .. 1 III. Local. Nervous 104 57 47 32 22 6 7 4 16 12 5 1 2 17 84 Circulatory 51 24 27 1 .. 1 5 3 19 20 2 2 2 10 37 Respiratory 303 167 136 90 87 5 3 15 49 51 3 .. 2 30 271 Digestive 36 17 19 6 4 1 1 1 14 8 1 . 2 8 28 Urinary 16 4 12 1 .. .. .. .. 5 9 1 . .. 5 11 Generative 7 1 6 .. .. .. .. 3 4 .. .. .. .. 1 6 Locomotory 3 1 2 1 1 1 .. .. .. .. .. .. .. .. 3 Integumentary 1 .. 1 1 .. .. .. .. .. .. .. .. .. 1 .. IV. Developmental. Premature Birth, Low Vitality & Congenital Defects. 82 46 36 81 1 .. .. .. .. .. .. .. 2 8 72 Old Age 22 7 15 .. .. .. .. .. 2 11 9 1 1 2 18 V. Violence 32 20 12 19 2 1 1 3 3 3 .. .. .. 4 28 VI. Illdefined and Illdefined . 4 4 .. .. .. .. .. .. 3 1 .. .. .. .. 4 Not Specified ( Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1071 545 526 385 219 31 41 74 165 134 22 5 22 122 922 31 If to the deaths registered as occuring in the sub-district, one hundred and seventy-nine other deaths in outlying institutions, of persons said to belong to the sub-district, be added, the total of 1,250 deaths will give an apparent death-rate of 18.75 per thousand. But this method makes no allowance for the numerous persons who die in the sub-district belonging to other places and who attend the Metropolitan Hospitals as out-patients, more especially the Brompton Hospital for Consumption, the Cancer Hospital and the Victoria Hospital for Children; being sent up from various places, and temporarily residing in the subdistrict as a convenient and inexpensive locality. Outlying Reference to Table III. will shew that one institutions, hundred and seventy-nine persons died in Hospital, Workhouse Infirmary, Asylum Board Hospital or Lunatic Asylum, who were registered as being inhabitants of East Battersea. In many cases the only title they possessed to be included amongst our parishioners being that they were members of families residing here, they themselves being employed elsewhere as domestic servants or employes. TABIE III. Deaths in Outlying Institutions. EAST BATTERSEA. Total. Skx. Aoe. | Institutions. Male. Female. Under 1. 1 to 60. 60 and upwards. Union Infirmary General & Special Hospitals. Asylums Board Hospitals. County and other Lunatic Asylums Disease. Small-pox 15 5 10 1 14 .. .. .. 15 .. Scarlet Fdver .. .. .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. Enteric Fever 3 1 2 .. 3 .. .. 1 2 .. Diphtheria 7 4 3 1 6 .. .. 7 .. .. Whooping Cough .. .. .. .. .. .. •• .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Other Zymotic Disaasas 6 3 3 2 4 .. 3 2 1 . . Tubercular Diseases 27 14 13 1 25 1 11 15 .. 1 Cancer 13 7 6 .. 7 6 6 6 .. 1 Rheumatism 1 .. 1 .. 1 .. .. 1 .. .. Respiratory Diseases 22 14 8 .. 11 11 11 11 .. .. Ci.culatory Diseases 18 12 6 .. 16 2 6 12 .. .. Nervous Diseases 18 11 7 .. 13 5 9 4 .. 5 Other Diseasas 35 18 17 2 21 12 10 25 .. .. Violence 14 9 5 •• 12 2 •• 14 •• •• Totals 179 98 81 7 133 39 56 98 18 7 32 It will be seen that the following was the mortality in the several institutions, viz :— General and Special Hospitals 98 Wandsworth & Clapham Union Infirmary 56 Metropolitan Asylums Board Hospitals for Small-pox and Fever 18 County and other Lunatic Asylums 7 Total 179 Ages at Under one year 385 infants died, being 35.9 Death. of the total mortality. Between one and five years 219 deaths were recorded, equal to 20.4 percent. Together 604 deaths occurred under five years of age, being 56.1 percent, of the 1,071 deaths registered. This was distinctly an improvement upon the infantile mortality of the preceding years when it was 65.4 per cent, of the total deaths. Twenty-two persons were stated to have died from old age, the number at 80 years and over being also 22. Zymotic Table IV. illustrates the incidence of the in- Diseases. fectious diseases for the last ten years. It must not be forgotten that the population of the sub-district has doubled during that period. TABLE IV. Zymotic Mortality in the East Battersea Sub-district. 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 Small-pox 7 28 5 1 1 17 .. .. 3 1 Measles 20 47 6 47 22 60 33 95 92 49 Scarlet Fever 34 18 19 44 63 20 36 17 17 3 Typhus Fever 6 17 12 13 15 17 14 14 2 1 Enteric Fever 23 8 Diphtheria 3 1 4 6 2 3 7 6 7 8 Whooping Cough 53 26 63 39 43 37 56 53 60 47 Epidemic Diarrhoea 60 47 71 43 78 45 37 51 93 63 Other Zymotic Diseases 23 22 20 20 13 18 11 19 20 13 Total Deaths from Zymotic Diseases 206 206 194 218 237 217 194 185 317 193 Zymotio Death-rate 4.4 4.3 3.7 3.9 4.3 3.7 3.2 3.0 4.9 2.8 Death.rate from all Diseases 19.0 19.2 17.3 17.5 18.9 16.8 16.4 16.5 18.5 16.0 33 It will be observed that the number of deaths from these diseases has been unusually low during the year under report. In fact the greatly diminished death-rate is largely due to this circumstance. Small-pox caused but one death in the sub-district, that of an un vaccinated girl of 15 years of age. The girl took the disease from her mother and no medical attendance was provided for either and the outbreak of disease concealed from the sanitary authorities, until an attempt to register the girl's death without a medical certificate informed them of its existance. The father, the legally responsible person, contracted the disease and was removed to the Small-pox Hospital where he also died. About the same time two unvacciuated children of another family were brought from an infected house in Lambeth. These children were removed to the Smallpox Hospital, where they both died. There was a third child in this family which had been vaccinated and which was sleeping with the others, but was not attacked by the disease. A more convincing proof of the efficacy of vaccination could not be adduced. In the hospitals of the Metropolitan Asylums Board 15 deaths of inhabitants of the sub-district occurred. There was a severe outbreak of this disease during several months of the year, amongst the parish poor 103 cases were recorded. Isolation by immediate removal of those attacked, re-vacoination of the inmates of the house, and disinfection of the rooms, clothing and bedding, and in many instances the destruction of the latter, effectually suppressed the epidemic. Measles.—This disease has also been widely prevalent during the year, and although fatal in but relatively few cases as compared with the number attacked, and then by intercurrent maladies such as Bronchitis or Pneumonia, which are frequently the result of exposare or careless 34 nursing, is most difficult to suppress; as the infectious stage occupies a considerable proportion of the 14 days' incubation which is found to exist in this disease, and this before any rash appears upon the skin. The large number of 49 deaths was rocorded and represents an enormously greater number of children attacked. Whooping-Cough was prevalent, and fatal in 47 cases, frequently in combination with, or following Measles. Scarlet Fever was conspicuous by its absence, but one fatal case being registered. There are, however, indications of an approaching epidemic. Diarrhoea was fatal in 63 cases, about the usual proportion, and in nearly every case in hand-fed children, clearly indicating the source of the malady. Fevers.—Typhus is credited with one death during the year. Sporadic cases of this disease undoubtedly crop up from time to time, although some authorities consider them all to be really abnormal cases of Typhoid or Enteric Fever. The latter disease caused death in five instances, very much fewer than in the year 1884, and shewing in conjunction with the small number of deaths from other diseases of the same class, the very excellent sanitation of the sub-district. Three other cases of Typhoid died in hospital. Diphtheria.—This disease like the last mentioned depends upon the sanitary condition of a district, more especially of its sewers and water supply. But 8 deaths were registered during the year, 7 others however took place in the various hospitals. other Zymotic These include 8 cases from Puerpural Diseases. Fever and 5 from Erysipelas, together 13, and are below the average in number. 35 other Diseases Reference to Table V. will shew the of the Non- incidence of these diseases during 1885 and Zymotic Class. the preceding nine years, it will be seen that they do not differ much in numbers from year to year, slowly rising with the increase of population, but not keeping pace with such increase, the population having doubled in the period, and these diseases only having increased some 20 percent. Diseases of the Respiratory Organs as usual head the list with respect to numbers. These do not include Consumption which is grouped with Tubercular diseases. The former diseases included 303 deaths and the latter 181, together 484, or 45 per cent of the total mortality. Diseases of the nervous system including Brain disease caused 104 deaths, of the Circulatory including Heart disease 51, and from Premature Birth and Low Vitality 82 deaths. All these were below the average, the increased population being taken into account. TABLE V. Comparative Table of Deaths from Non.Zymotic Diseases for ten years, 1876-85. Diseases. 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 Tubercular 206 193 116 167 248 173 192 175 213 181 Neivous System, Brain, &c. 67 32 110 97 110 128 112 119 128 104 Circulatory (Heart, &c.) 36 38 52 38 28 53 47 44 53 51 Respiratory 189 203 217 271 190 188 258 248 241 303 Digestive 35 32 33 32 41 39 23 42 22 36 Urinary 16 9 9 11 18 12 20 16 15 16 Generative, including Penturition 1 1 3 2 4 7 3 9 4 7 Locomotory, Bones, &c. 4 .. .. 3 1 . . 2 .. 4 3 Integumentary .. .. 1 .. 5 1 1 .. .. 1 Premature Birth 66 67 45 55 69 67 63 74 116 82 Uncertain Seat (Cancer, Syphilis, Dropsy, &c. 14 23 18 21 12 27 15 22 25 36 Old Age 13 13 9 20 22 14 18 21 19 22 Violence 32 26 25 26 33 24 30 24 18 32 Not Specified 9 9 13 17 12 11 14 24 9 4 Totals 687 699 701 760 793 649 798 818 867 878 36 deaths not certifed. Nineteen such cases occurred in 1885. Of these eleven were submitted to the Coroner, who deemed an inquest unnecessary, all being from natural causes and the circumstances not being of a nature to justify a formal enquiry. In the last case, a concealed case of Small-pox proved fatal, no medical man being called in. The case is the subject of comment elsewhere. inquests. in addition to eleven cases of uncertified death in which an informal inquiry by the Coroner took place, forty-five inquests have been held during the year. In all investigation in fifty-six cases of death have been made by him. The particulars of the cases in which inquests have been held may be summarised as follows ;— In the eight cases in which the most objectionable course was taken of registering the death without either a medical certificate or the Coroner's authority the following aie the details :— Age 11 months Diarrhoea Convulsions attended by an unregistered practitioner. „ 8 days Convulsions „ ,, 4 months Consumption „ „ 4 hours Convulsions attended by a midwife. „ 6 days „ „ ,, 30 hours „ „ ,, (not stated) Premature Birth „ „ 15 years Small-pox no medical attendant. 37 From Natural causes 14 From Accidental causes— Asphyxia (15 infants) 16 Concussion, Fracture, &c. 5 Drowned 3 Killed on Railway 2 Erysipelas from wound-Scald or Burn, Overdose of Jalap, each 1 3 — 29 Homicidal— Suicide from Prussic Acid, Hanging, each 1 2 45 an increase of eight inquests on the preceding year. Of the asphyxiated infants death took place in ten instances between Friday night and Monday morning, another on Christmas eve, two on Tuesday and the other two on Thursday. In one of the latter cases the Coroner did not hold an inquest. Social The deaths registered during 1885 shewed Position. the following relative proportions occurring in the several classes. No. Percent. Nobility and Gentry 5 = .47 Professional Class 22 = 2.05 Middle and Trading Classes 122 = 11.39 Industrial Labouring Classes 922 = 86.09 Totals 1,071 100.00 The most noticable feature in the table is the diminution in the numbers of the upper classes which has been gointr on for some years, and the steady increase in the professional and trading classes. The proportions do not vary much however from year to year. Vaccination. The register of public vaccinations shews that the Public Vaccinator performed the following successful operations during 1885 at the appointed station. Primary Vaccinations 1593 Pe-vaccinations 285 Total 1878 88 The total number of births registered was 2,496, so that 63 percent, of the children born in the sub-district were vaccinated as above. It is but right to state that during the various several epidemics of Small-pox which have occurred in the sub-district, and in which every case has been investigated, not one of the persons attacked has been vaccinated at the public vaccination station. Sanitary In order to define the area of work of the Operations. Assistant Sanitary Inspectors a revision of the boundaries of the Wards in East Battersea has been made for such purpose. Ward No.1, in which 3,200 houses were situated, has been made to include the Beaufoy Estate containing 800 houses, bringing up the total to 4,000 houses, and has been assigned to Assistant Inspector Freeman. Ward No.2 contains in East Battersea 5,300 houses, (1,000 houses in No.2 Ward being in West Battersea, from the Latchmere Road to Falcon Road), and the 800 houses in the Beaufoy Estate having been attached to No.I Ward, the remaining 4,500 houses have been assigned to Assistant Inspector Poole. The work of these officers is fairly equalised, and they have given me great satisfaction by the manner in which they carry ont their important but sometimes very disagreeable duties. During 1885 the large number of 8,111 houses and premises were inspected with the result that 617 notices were served, including more than twice that number of defects. These were all properly attended to and the necessary works completed, with the exception of 188 cases in which it was necessary to serve second notices. 39 But three cases had to be taken before the Magistrate, iu each of which compulsory orders were obtained, and the works executed. The number of houses disinfected after infectious diseases was 257, the largest number yet disinfected in any year. Increasing experience of the efficacy of sulphurous acid gas fumigation but confirms the high estimation in which the method is held, for cheapness, safety and efficiency. It will be observed that no case of infectious disease recurred after such disinfection. In the summary of sanitary operations to be found in the appendix the detailed statement will shew that very many defects have been remedied by the execution of the necessary works, entailing as a rule in each case repeated inspections. Defective house drains required cleansing and repairing in 590 instances, in addition to which 550 new or relaid drains were carried out. Syphon traps were laid to drains in 107 instances. These constitute altogether valuable improvements to the house drainage of the sub. district, which has been much improved during the last few years, but few of the grosser defecfs being now found. it is however a matter of primary importance that the ventilation and treatment of the gases generated in the main sewers should receive earnest attention, as any back pressure of gas readily forces the weak water seals of the domestic drains to the injury of the health of the inhabitants. In fact the time has arrived when a more systematic and scientific method of ventilating the main sewers must be devised and adopted than the present weak expedient of surface ventilators, which arc offensive 40 when in operation and readily blocked up by road debris. Some form of upcast shaft to carry the gaseous contents of the sewers far above the house level should be devised and put in operation, and if practicable such gases should be so treated by heating, washing, disinfection or some analogous process as to become inoffensive and not dangerous either from their own toxic constituents or as carriers of disease germs. The question of the removal of house refuse has been so constantly before the Local and Sanitary Committees and the Board during the year, that it is unnecessary for me to refer to the subject except to say, that the necessity for the more frequent removal of such refuse was the subject of much unanimity of opinion, which will doubtless have the result of effecting great changes in that direction. The Board has during the year made regulations applicable to tents and vans used for human habitation, with valuable results. A report of the Chief Inspector of Nuisances dated November 2nd, 1885, upon the result of an inspection of such habitations, shewed overcrowding of the worst kind. Thus in one instance a man and several children were found to sleep in a van with but 84 cubic feet of air per adult, and half that amount for the children. One cistern of 57 gallons capacity served for 23 persons, many of different families. The vans were cleanly but ill ventilated, but the tents were dirty, damp and crowded to excess. The regulations will, when in force, remedy these defects. Bakehouses. These have all been properly inspected twice at least during the year and the necessary cleansing and lime.whiting duly attended to. The whole of the+ 41 bakehouses in East Battersea are in a cleanly and sanitary condition and in accordance with the Board's Regulations. Cow-houses. These are diminishing in number year by year. The few left in the sub-district are in accordance with the regulations. Slaughterhouses. All were in such a condition that their relicensing was not opposed. It is to be desired that a public slaughter-house under the control of the Board may be before long established and private slaughter-houses connected with dwellings be abolished. Cholera, which in obedience to the laws of the progression which it has hitherto observed when occurring in this country should have been with us during 1885, failed to put in an appearance. The fatal cases of diarrhoea which usually proceed cholera were but 63 compared with 93 in the year 1884. It is therefore to be hoped that we have escaped an epidemic, which we are well prepared to meet should it appear. The disease appears still to linger in the hotter and dirtier towns of Southern Europe. In conclusion I have to congratulate the Board upon the satisfactory sanitary report which the condition of the sub-district of East Battersea enables me to make ; a condition which raflects much credit upon those having charge of its sanitation, and by whose vigilant supervision and courteous assistance the officers are enabled to perform their duties with satisfaction to themselves and credit to the sanitary authority under whom they act. 42 Mr. Pilditch, the Surveyor for Battersea, has always readily accorded to me his invaluable aid and great experience, and the past year has enabled me to avail myself freely of both. Mr. Richards, the Chief Inspector of Nuisances, has performed his duties in a very perfect manner during the year, and I have to thank him for much valuable assistance. W. H. KEMPSTER, M.D., Medical Officer of Heath for East Battersea. 43 WEST BATTERSEA. The year under report was marked by a greater number of deaths than its predecessor, consequently the death rate is raised exactly 1.0 per 1,000, but though the deaths have increased by 76 it is gratifying to observe that the increase is in those classes of disease over which we as sanitarians have little or no direct control; indeed, in such diseases of the zymotic class, there is a decrease of 17 as compared with those of the previous year. Doubtless the stability of the low death-rate from this class of disease for some years past indicates that the improved sanitary arrangements are telling upon the general health of the people, and is some recompense to the Board for the great efforts constantly being put forth and the expense incurred. Those diseases of the preventative class which have been most fatal, are Measles, Whooping-cough, and Diarrhœa—no less than 196 under five years of age being returned out of a total of 234. It would be well if parents would take more care of their children whilst suffering from the former disease, for in every case Lung complication—to which they are at that time particularly susceptible—is given as the cause of death. Diarrhœa was not nearly so severe as in former years, which may in some measure be accounted for by the low temperature which prevailed during the summer months, it attained its greatest fatality in the month of August, and was almost entirely confined to young children. 44 Small Pox which had shown signs of becoming epidemic in 1884, but abated towards the end of the year, returned with renewed vigour in the present year. The cases were nearly all in adults, and were with one exception removed to hospital, the exception being the case of a man found dying when visited. The arrangements for removing these patients are as perfect as they well can be, no delay having occurred in a single case. It is no doubt owing to rapid isolation that the disease was confined to narrow limits, in all 44 cases were removed; it was not confined to any particular part of the district, but was general, and in most cases it was difficult to trace its origin, and may be attributed to persons having had the disease, concealing it; their clothes not being submitted to disinfection and wearing them in public, so spreading it broadcast, as the following case will shew: An adult female convalescent from Small Pox paid a visit to her parents at-; in a fortnight her mother and two sisters died of the disease, there was no Small Pox in the neighbourhood nor had there been, and there is not the least doubt that it was communicated by the visitor. We should have known nothing of it had not tho Medical Officer of Health written asking me to ascertain if there had been any Small Pox in the house from which she left. This is another instance in which the compulsory notification of infectious disease would have been of valuable service. Population. The population estimated on the basis pursued by the Registrar-General for themiddle of the year would be 64,317, this however must not be considered as accurate as the birth-rate is again 4.0 per thousand more than that of the census year when the population was exactly known. The rapid development of the Broomwood Estate, West side, 45 Nightingale Park, &c., would tend to show that our population has grown at a greater rate than that allowed by the Registrar-General. Mortality. The total number of deaths returned by the Registrar as having taken place in this sub-district was 1395—of which 666 were males and 729 females. In 1884, 1319 were returned, there is therefore an increase of 76 on that year. In addition to the above, 68 took place in public institutions outside the district making a total of 1463 persons who died connected with this division of the parish. Of the 1395, 269 occurred in Public Institutions, viz:—254 in the Infirmary and 15 in the Bolingbroke Hospital; these are 14 below those of the previous year, when 283 were returned. Of the deaths which took place in the Infirmary 76 belonged to West Battersea, the remainder to other sections of the district. Deducting the 269 deaths in Public Institutions 1,126 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. Second Quarter. Third Quarter. Fourth Quarter. 395 311 325 364 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 1885 856 854 820 908 1002 1010 1195 1222 1341 1319 1395 Out-door with reference to Infirmary. 46 The deaths in the Infirmary were 254—males 146, females 108. The death-rates per 1,000, including Infirmary deaths belonging to this sub-district and out-lying Institutions:— 1875 1876 1877 1878 187!) 1880 1881 1882 1883 1884 1885 20.2 19.5 17.1 18.5 20.0 16.8 19.0 18.0 18.6 18.8 19.8 The deaths during the past year not including those occurring in its Institutions, nor those in out-lying Institutions, numbered 1,126; these give a death-rate of 17.5 per 1,000. Birth-rate.—The number of births registered were 2558, of which 1,288 were males and 1,270 females, being a difference of 18 in favor of the males. The rate is 39-8 per 1,000, being 4.8 per 1,000 more than that of the census year, at the same time the same increase of population as in the preceeding decennial period has been allowed. The return for each quarter was as follows :— First Quarter. 694 Second Quarter. 583 Third Quarter. 642 Fourth Quarter. 638 Natural Increase. The above number of births are 1,303 in excess of the deaths, and constitute the year's natural increase, more than double those of the deaths. 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:— 47 TABLE II WEST BATTTERSEA Population (Census) 1881 52,587 Official Population in middle of 1885 64,317 Total Deaths from each Class of Disease, &c„ in the Sub-District, Sex. Age. Social Position. Males, Females, Under 1 year. From 1 to 5 years, From 5 to 10 years. From 10 to 20 years. 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, CAUSES OF DEATH. I. Zymotic. Small-pox 1 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 Measles 63 29 34 13 45 4 1 .. .. .. .. .. .. 5 58 Scarlet Fever 5 1 4 .. 3 1 1 .. .. .. .. .. .. 1 4 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 9 3 6 1 1 .. 3 4 .. .. .. .. .. 3 6 Puerperal Fever 10 .. 10 .. .. .. .. 10 .. .. .. .. .. .. 10 Diphtheria 2 .. 2 .. 2 .. .. .. .. .. .. .. .. .. 2 Whooping Cough 74 34 40 38 35 1 .. .. .. .. .. .. .. 3 71 Erysipelas 7 4 3 2 .. .. .. 3 1 1 .. .. .. .. 1 Diarihcea, Dysentery, and Cholera 63 33 30 54 2 .. 1 .. 3 3 .. .. .. 8 55 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 234 105 129 108 88 6 7 17 4 4 .. .. .. 20 214 II. Consitutional Gout and Rheumatism.. 9 7 2 .. .. .. 1 3 3 2 .. 1 .. 4 4 Cancer & other Tumours Other Constitutional 31 8 23 .. 1 .. .. 1 18 10 1 .. • • 2 29 Diseases 8 2 6 .. 1 .. 1 3 1 2 .. .. 2 1 5 Tubercular Phthisis 138 77 61 5 6 .. 16 61 49 1 .. 3 1 11 123 Tabes Mesa 71 37 34 60 8 .. .. 2 .. 1 .. .. .. 11 60 Hydrocephalus 9 3 6 4 5 .. .. .. .. .. .. .. .. .. 9 Scrofula 21 3 18 10 9 1 .. 1 •• .. .. 1 0 3 17 III. Local. Nervous 178 91 87 58 17 4 .. 10 26 53 6 3 1 26 148 Circulatory 108 52 56 6 1 2 .. 17 33 42 5 3 2 18 85 Respiratory 327 159 168 112 70 1 1 23 46 69 5 2 1 33 291 Digestive 52 22 30 7 .. .. 1 8 17 17 2 2 2 16 32 Urinary 30 21 9 1 1 1 .. .. 14 9 1 3 .. 4 21 Generative 16 .. 16 1 .. .. 1 9 2 2 1 .. .. 3 13 Locomotory 5 2 3 1 .. .. .. .. 1 3 .. .. .. .. 5 Integumentary .. 4 1 3 1 .. 1 .. 1 1 .. .. .. .. •• 4 V. Developmental. / Premature Birth and \ Low Vitality 55 33 22 55 .. .. .. .. .. .. .. .. .. 4 51 j Congeutial Defects .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. V Old Age 54 19 35 .. .. .. .. .. .. 26 28 •• .. 6 48 V. Violence 29 16 13 15 2 .. 1 3 7 .. 1 •• •• •• 29 VI. Illdefined and Not Specified Illdefined .. 15 8 7 4 .. .. .. 4 4 3 0 .. .. 2 13 Not Specified 1 .. 1 .. .. .. .. .. .. 1 •• •• •• •• 1 Totals 1395 666 729 448 209 16 35 166 226 245 50 18 9 164 1204 Including all deaths in the Infirmary. 48 Zymotic Mortality. The deaths from this class of disease were 234, of which 105 were males and 129 females, and are 17 less than those of the previous year. The greatest fatality was from Whooping-cough, Diarrhoea, and Measles, which collectively gave 200 of the total number. There is compared with last year an increase in Whooping-cough, Measles, and a decrease in Diarrhoea, Typhoid Fever, Child-bed Fever, Scarlet Fever, and Diptheria. From Fevers other than Scarlet and Measles there were 19 deaths, classified as follows:— Typhoid or Enteric 9 Puerperal 10 19 Of the total number 108 were under 1, 88 from 1 to 5 years of age, 13 from 5 to 20, and 25 from 20 upwards. No less than 196 of the total 234 were under 5 years of age. The following table contrasts all deaths from Zymotic causes during the past 10 years; also the death rate:— TABLE IV. Zymotic Mortality in the West Battersea Sub-district. 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 Small Pox 3 13 2 2 .. 4 1 .. 2 1 Measles 35 8 34 43 8 50 30 52 42 63 Scarlet Fever 20 8 4 55 30 25 35 26 14 5 Diphtheria 5 2 4 7 3 9 4 2 11 2 Enteric Fever 19 25 15 27 10 10 14 12 20 9 Whooping - Cough 32 18 36 11 23 31 47 46 46 74 Epidemic Diarrhoea 43 22 41 17 61 53 39 64 82 63 Other Zymotic Diseases 11 11 14 12 11 16 24 16 34 17 Total Deaths from Zymotic Diseases. 108 107 150 174 140 198 194 218 2)1 234 Zymotic Death-rate 4.7 2.8 3.8 4.2 2.9 3.8 3.6 3.6 4.0 3.6 Death-rate from all Diseases . 19.5 17.1 18.5 20.0 10.8 19.0 18.0 18.6 18.8 19.8 Other causes of Death than Zymotic. From these classes 1161 deaths were returned being 93 in excess of those of last year. There were 212 from Bronchitis; 49 Pneumonia, 93; Other Lung Diseases, 32; from Circulatory Disease, 108; Brain and Nerves, 178; Digestive Organs, 52; Premature Birth, Low Vitality, 55; Old Age, 54; Cancer, 31; Violence, 29 ; &c. Diseases of the Respiratory Organs, Cancer, Premature Birth, Old Age, shows an increase as compared with last, whilst those of the Digestive Organs and Brain and Nerves a slight decrease. From the Tubercular Class, 239 were returned, viz:— Phthisis, 138; Tabes Mesenteries, 71; Scrofula, 21; and Hydrocephalus, 9. Of those from Phthisis, 27 were under 20; and 111 from 20 to 60 years of age. The deaths from Old Age were 54 against 45 of last year, the eldest being—females, 90, 90, and 93 respectively; the opposite extreme we find the duration of life to have been in 58 instances, a few days, 19 a few hours, and in 3 a few minutes. Of the 1,161 deaths, 561 were those of males and 600 of females. The following table contrasts all deaths from nonzymotic causes during the past 10 years. 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 Tuberoular, including Phthisis 149 172 143 163 196 210 — 198 255 236 239 Of Brain, Nerves, &c, 119 148 137 136 117 147 173 168 170 178 Of the Heart, &c. 49 55 53 56 72 94 83 85 95 108 Of the Respiratory Organs, excluding Phthisis 160 124 204 260 215 266 272 318 248 327 Of Digestive Organs 19 37 27 27 47 59 59 68 63 52 Of Urinary Organs 13 14 10 20 15 26 21 32 19 30 Of Organs of Generation 8 8 3 9 9 14 14 11 12 16 Of Joints, Bones, &c. 4 1 2 2 3 15 12 19 12 5 Of Cancer 23 22 23 14 22 21 25 33 17 31 Premature Birth, Low Vitality, Malformation, &o. 30 30 31 36 70 37 78 30 33 55 Of Uncertain Seat and other diseases 37 25 29 17 36 27 27 13 39 29 Age 53 47 58 57 35 31 37 64 45 54 v iolenoe 18 23 28 13 23 40 30 20 39 29 Constitutional 4 7 11 16 4 10 6 1 10 8 Totals 686 713 751 828 864 997 1028 1123 1068 1161 50 The causes of death of persons dying without the district will be found in the table following, they were 68 in number. TABLE 111. Deaths in Outlying Institutions. WEST BATTERSEA. Total. Sex. Age. Institutions. Male. Female. Under 1. 1 to 60. 60 and upwards. Union Infirmary General & Special Hospitals. Asylums Board Hospitals. Disease. Small Pox 6 2 4 .. 6 .. .. .. 6 Scarlet Fever 1 1 • • .. 1 .. .. .. 1 Typhus Fever .. .. .. .. .. .. .. .. Enteric Fever 2 1 1 .. 2 .. .. 1 1 Whooping Cough .. .. .. .. .. .. .. .. •• Measles .. .. .. .. .. .. .. .. • • Other Zymotic Diseases .. .. .. .. .. .. .. .. .. Tubercular Diseases 10 5 0 .. 10 .. .. 9 1 Cancer 2 1 1 .. 2 .. .. 2 .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 9 7 2 .. 9 .. .. 9 .. Circulatory Diseases 10 5 5 .. 10 .. .. 10 .. Nervous Diseases 7 6 1 .. 7 .. .. 5 2 Other Diseases 18 5 13 2 l6 .. .. 14 4 Violence 3 2 1 •• 3 .. .. 3 •• Totals 68 35 33 2 66 •• •• 53 15 Those occurring in Institutions within the district are included in the General Mortality table. inquests. Enquiries were held on the bodies of 32 males and 23 females, in all 55, being 4 less than those of the previous year. The verdicts were as follows:— From Natural Causes 30 „ Accidental 20 Found Drowned 2 ,, Dead 1 Suicide 2 55 Of the Accidental causes 2 were killed on the railway, 3 by falls, 2 whilst bathing, 1 by poison, 3 from burns, 6 suffocated in bed. 51 The suicides were respectively:— 1 by Poison. 1 ,, Drowning. In addition to the above inquests, 13 cases of sudden death were submitted to the Coroner who did not deem an enquiry necessary. Of Infants suffocated in bed with their parents there are 6, and occurred on the following dates:— Tuesday, 27th January. Sunday, 8th March. Sunday, 15th March. Thursday, 11th June. Saturday, 25th July. "Wednesday, 30th September. Deaths not Certified. Under this head the Registrar-General places 17, at the same time as stated above 13 were submitted to the coroner who issued his order for burial, therefore it cannot be said they were cor signed to the grave without some enquiry, the remaining four were those of Infants born prematurely whose period of existence was registered by minutes and hours, and whose mothers had been attended by midwives. Social Position. The per-centage of deaths, in relation to social position was as follows:— Nobility and Gentry 18 = 1.28 Professional 9 = .64 Middle and Trading Class 164 = 11.78 Labouring 1204 = 86.3 1395 100.00 52 Disease and Mortality among the Union Poor. The number of cases which came under treatment was 609—277 being males and 332 females, being nearly 100 in excess of those of last year, indeed there has been a steady increase of parochial cases for the last four years, this increase has been in general diseases and Small Pox, 44 cases of the latter having been removed to hospital. Of the total, 29 died giving a death-rate of 4.7 per cent. Sanitary Matters. Reference to the table of Sanitary operations will show the large amount of work carried out during the year, the district is now equally divided and an Inspector appointed to each who systematically visits tne houses in his district. No. 3 contains 5,400, No. 4 about 5,000, making a total of 10,400, of which 8,460 a larger number than ever before dealt with, were inspected, and the results inserted in the books.—1,000 first notices were served to remedy defects, of which 797 were at once complied with, in the remainder second notices had to be served, and the Magisfrate appealed to in five only for compulsory orders. A large number of closets were found without any water supply, a condition of things which has no right to exist for very obvious reasons; to 307 water has now been laid on. Disinfection has been actively carried out and actual destruction of bedding, &c. where necessary, in all 169 houses were disinfected after infectious disease, and in no instance has a second case occurred after its use; the means used are fumigation by sulphurous acid, and judging from results appear in every way satisfactory, though the prevailing opinion of the 63 present day is that all textures should be disinfected by heat, every person must admit the destroying power of heat, and if the temperature which will destroy the germs of disease is known, then nothing can be more certain in its action. This matter has been recently investigated by Dr. Parsons, one of the Medical Officers of the Local Government Board, who after very exhaustive experiments arrives at the same conclusion. The following will show under what conditions some persons will live.—F. W-, who carried on the business of gut cleaning, used an adjoining shed as a stable with two stalls, in one was a horse, and in the other (which was used as a living and sleeping room) his wife and five children; thus 7 persons were residing in the stall of a stable with a horse in the adjoining stall, no ventilation or light with the exception of the door. The cubical contents of the whole being 1,560 feet. Proceedings were taken forthwith. The following, of which examples constantly occur will shew the necessity of legislation in reference to drains of new houses, —Mr. S., Ousely Road complained of an offensive smell in his house, on inspection being made and the drains opened up, it was found that a branch drain which had been brought into the house from the sewer, but not being needed, was left unstopped, so allowing sewer gas to pass freely into the house. Complaints were made to the Metropolitan Board of Works of the dilapidated condition of houses in Europa Place, they having acquired them for the purpose of the New Bridge, at once demolished them. 54 Cow and Slaughter-houses were all inspected and the licenses renewed. Bake-houses are visited twice yearly and all are in good sanitary and cleanly condition. Mortuary. In August a register was commenced to be kept of all bodies taken into the Mortuary; since that time 29 have been received. There is also a room set aside for post-mortem examinations which can be used by all medical men in the parish. Throughout the year the Assistant Inspectors have worked well, under the supervision of Mr. D. Richards, who is a most active officer, and I am pleased to be able to bear testimony not only to the great interest he takes in his work, but also to his knowledge and the tact displayed in carrying out often-times most disagreeable duties. J. OAKMAN, Medical Officer of Health for West Battersea. 55 CLAPHAM. It is with much satisfaction that I present the following report of the sanitary condition of this sub-district during the year 1885. During the period under report, the health of Clapham, as tested by various criteria has been most satisfactory. (a) The death-rate has been lower than at any previous recorded period, and this notwithstanding the fact that the density of the population of Clapham is steadily increasing. The death-rate was in fact lower than that of most of the healthy rural districts. (b) The deaths from Infectious and such like diseases, (classed together under the name Zymotic) were much below the average. The zymotic death-rate was lower than it has previously been known to be; and we may reasonably infer that infectious diseases were prevalent only to a small extent. Special stress may be laid on 66 this low zymotic death-rate, as zymotic diseases are par excellence preventible diseases, and those with which therefore sanitarians are particularly concerned. In the following pages details are given of the vital statistics and sanitary work of the past year, from which a more complete knowledge of the sanitary condition of Clapham may be obtained. Population. The first requisite in ascertaining the various rates of mortality and vitality, is an accurate knowledge of the population. Owing to our being midway between two census enumerations this is impossible; but in the following estimate the plan adopted by the Registrar General is followed. Assuming the rate of increase to be the same as in the decade previous to the last census the population of this sub-district in the middle of 1885 was 40,832. Births and Birth-rate. The number of births registered was 1,030, of which 511 were males and 519 females. The annual birth-rate was 25.22 per thousand of the estimated population, which (see table I.) was the lowest for ten years. The birth-rate for the whole Metropolis was 32.6 per thousand, the lowest rate on record since 1850. Deaths and Death-rate. During the year 1885, 508 deaths, 237 of males and 271 of females, were registered in the sub-district. These are equivalent to an annual death-rate of 12.14 per thousand, the lowest hitherto recorded in Clapham. (See table). The death-rate for 57 the whole of London was, during the same period, 19.7 per thousand inhabitants, and for the twenty-eight great towns of England and Wales in the proportion of 20.5 per thousand inhabitants. The natural increase of the population of Clapham, i. e., the excess of births over deaths was 521, giving a rate of 12.7 per thousand. TABLE I. Birth and Death-rates. YEARS. Births. Birth-rate. Deaths from all Causes. Death-rate. Rate of Natural Increase. 1876 1,095 34.3 545 17.7 15.8 1877 1,029 32.4 467 14.8 18.5 1878 1,019 34.2 580 18.1 15.9 1879 1,125 34.1 561 17.0 17.0 1880 1,082 29.7 544 14.9 15.1 1881 1,059 28.9 499 13.5 15.3 1882 1,081 28.8 544 14.5 14.3 1883 1,085 28.25 580 15.1 13.1 1884 1,123 28.32 543 13.7 14.6 1885 1,030 25.22 508 12.44 12.7 Deaths in Out-lying Institutions The deaths already enumerated do not include those of inhabitants of this subdistrict who have died in out-lying institutions, such as the Union Infirmary, the Asylums Board Hospitals for Infectious Diseases, and the General and Special Hospitals of the Metropolis. In the following table, these additional deaths, 77 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. 58 TABLE II. Deaths in Outlying Institutions. DISEASE. Total. Sex. Age. Institutions. Male. Female. Under 1 1 to 60. 60 and upwards. Union Infirmary General & Special Hospitals. Asylums Board Hospitals. Small-pox 4 3 1 .. 4 .. .. .. 4 Scarlet Fever .. .. .. .. .. .. .. .. .. Diphtheria 2 2 .. .. 2 .. .. 2 .. Enteric Fever 2 2 .. .. 2 .. .. 1 .. Whooping-Cough .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases 2 2 .. .. 2 .. .. 2 .. Tubercular Diseases 9 7 2 .. 9 .. .. 7 .. Cancer 5 3 2 .. 2 3 .. 2 .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 6 3 3 .. 4 .. 2 4 .. Circulatory Diseases 14 7 7 .. 6 8 9 5 .. Nervous Diseases 15 10 5 .. 8 7 8 7 .. Other Diseases 17 4 13 2 5 10 11 6 .. Violence 1 1 •• •• 1 .. .. 1 .. Totals 77 44 33 4 45 28 35 37 5 It will be seen that 35 of the external deaths occurred in the Wandsworth & Clapham Union Infirmary, 37 in the various hospitals, and only 5 in the Asylums Board Hospitals. If these 77 deaths be added to the 508 occurring in Clapham, the death-rate becomes 14.32 per thousand living, as compared with 16.27 in the preceding year. This remarkably low inclusive death-rate bears out the conclusion already stated, of the excellent vital condition of this sub-district during the past year. 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. 59 TABLE III. STATISTICS OF MORTALITY. CLAPHAM. Population (Census) 1881 36,380 Official Population in middle of 1885 40,832 Area in Acres, 1233. causes of death. Total Deaths from each Class of Disease, &c., in the sub-district. Sex. Age. Social Position. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. From 10 to 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. I. Zymotic. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 3 2 1 .. .. .. .. .. .. .. .. .. .. 1 2 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 8 4 4 .. 2 .. 2 3 1 .. .. .. 3 1 4 Puerperal Fever 3 .. 3 .. .. .. 1 2 .. .. .. .. .. 2 1 Diphtheria 4 9 2 .. 3 1 .. .. .. .. .. .. .. 2 2 Whooping-Cough 25 9 16 10 15 .. .. .. .. .. .. .. 2 9 14 Erysipelas 2 .. 2 .. .. .. 1 .. .. .. .. .. .. .. 2 Diarrhœa, Dysentery, and Cholera 16 13 3 11 3 .. .. .. 1 1 .. .. 1 6 10 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 61 30 31 21 26 1 4 5 2 2 .. .. 6 20 35 II. Constitutional. Gout and Rheumatism 3 2 1 .. .. .. .. 2 1 .. .. .. .. 2 1 Cancer & other Tumours 16 4 19 .. 1 .. .. 1 7 7 .. 1 2 7 6 Tubercular Phthisis 48 27 21 1 2 .. 7 96 11 1 .. 8 .. 24 15 Tabes Mesa 7 4 3 3 3 1 .. .. .. .. .. 1 .. 3 3 Hydrocephalus 10 3 7 4 3 3 .. .. .. .. .. .. .. 3 7 Scrofula 3 2 1 1 .. .. 1 1 .. .. .. .. 1 1 1 Other Constitutional Diseases 1 .. 1 .. 1 .. .. .. .. .. .. .. .. .. 1 III. Local. Nervous 80 40 40 15 5 2 2 6 17 28 5 5 11 34 30 Circulatory 40 13 27 1 .. .. 2 7 10 19 1 5 6 15 14 Respiratory 120 58 62 35 20 4 1 7 21 28 4 5 13 31 71 Digestive 30 13 17 7 1 .. .. 4 7 11 .. 2 4 15 9 Urinary 6 .. 1 .. .. .. .. 1 3 2 .. .. 2 3 1 Generative .. .. 7 .. .. .. .. 4 2 1 .. .. 1 2 4 Locomotory 1 .. 1 .. 1 .. .. .. .. .. .. .. .. 1 .. Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. IV. Developmental. Premature Birth & Low Vitality 29 18 11 28 1 .. .. .. .. .. .. .. 2 7 20 Congenital Defects 7 6 1 7 .. .. .. .. .. .. .. .. .. 6 1 Old Age 31 9 22 .. .. .. .. .. .. 14 17 1 6 12 12 V. Violence 8 3 5 2 .. .. .. 1 4 .. .. .. .. 6 2 VI. Illdefined and Not Specified Illdefined .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Not Specified .. .. .. .. .. .. .. .. .. .. .. •• .. •• •• Totals 508 237 271 125 64 11 17 65 85 114 27 23 60 192 233 60 Age at death 42.8 per cent. of the total deaths occurred at various ages below 20 years, 24.5 per cent. being under 1 year, and 12.8 per cent. between 1 and 5. In the preceding year 53 per cent. of the total deaths occurred at ages below 20, 33 per cent. under 1 year, and 14.3 per cent. below 1 and 5 years. The proportion of deaths under 1 year to total deaths obviously will vary with the birth-rate. The larger the number of children of this age, and the greater the incidence of the causes of infantile mortality. It is therefore desirable to check the previous percentage of deaths under 1 year, by ascertaining the proportion of deaths of infants in the first year of life to registered births during the year, known as the Infantile death-rate. In Clapham this was 120 per thousand births, as compared with 160 in the preceding year, and with 148 for the whole Metropolis during 1885. The diminution in infantile mortality was largely due to the smaller mortality from zymotic diseases at this age, 21 as compared with 39 in the previous year. Scnile Mortality. The deaths of persons over 60 years formed 29 per cent. of the total deaths, as compared with 23.6 per cent. in the previous year. 29.4 per cent. of the total deaths occurred between 20 and 60 years of age, as compared with 23.5 per cent. in the previous year. These statements of the relative percentages of deaths at different groups of ages, can only be regarded as satisfactory so long as it is assumed that the relative proportion of people living at each age remains stationary from year to year. An increase of the relative number at any age, as by migration or an altered birth-rate, would increase the number of persons subject to the causes of death at the age in question, and so would increase the 61 percentage of deaths at that age as compared with the total deaths. The only way to avoid this fallacy is to ascertain the number dying at each group of ages from the death returns and the number living at each group of ages from the census, and then calculate the true death-rate for each separate group of ages. Unfortunately the number living at different ages can only be known by the decennial census, and in the interval one must be content with approximate calculations. An example of the results obtained from the last census is given in Table J of the Introductory Report at page 17. Social Position of Deceased. The relative number of deaths in the several social grades was as follows:— Nobility and Gentry 23 = 4.5 per pent. Professional Class 60 = 11.8 ,, Middle and Trading Class 192 = 37.8 ,, Industrial and Labouring Class 234 = 45 9 ,, In the absence of knowlege of the living population belonging to esch class, the true death-rate for each separate class is unobtainable. By comparing the percentage of total deaths with the percentage of deaths from zymotic diseases in each class a further indication of value may however be obtained. The total deaths from zymotic diseases were 62, of which none occurred in the first class, 9.6 per cent. in the second, 32.2 per cent. in the third, and 58.2 in the fourth. It will be seen that the proportion of zymotic disease in the industrial class was excessive, a fact in accordance with general experience. Zymotic Diseases. The following table gives the number of deaths from specific febrile diseases, as compared with previous years, and a similar comparison of zymotic and general death-rates. 62 The zymotic death-rate was 149 per thousand of the population, a lower rate than has been previously recorded. If the ten deaths from infectious disease occurring in outlying institutions be included, the zymotic death-rate becomes 1.73 per thousand, which is still very much lower than that for the whole of London. TABLE IV. Zymotic Mortality in Clapham. 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 Small-pox 14 12 3 .. 2 7 1 .. 2 .. Measles 13 5 23 17 19 10 15 33 33 3 Scarlet Fever . 13 4 12 12 21 15 26 8 3 . . Diphtheria .. . . 3 1 3 3 4 7 8 4 Enteric Fever. 5 4 5 9 4 3 7 3 4 8 WhoopingCough 17 12 29 25 25 13 17 16 15 25 Epidemic Diarrhœa 24 18 26 17 36 20 4 19 18 16 Other Zymotic Diseases 16 9 9 21 9 7 7 26 12 5 Total deaths from Zymotic Diseases 102 64 110 102 119 78 81 112 95 61 Zymotic Deathrate 3.3 2.0 3.4 3.1 3.4 2.1 2.1 2.9 2.3 1.49 Death-rate from all Diseases 17.7 14.8 18.1 17.0 14.9 13.5 14.5 15.1 13.7 12.4 An examination of the preceding table shews that no deaths occurred from Small-pox in the sub-district. Between January 30th 1885 and the end of the year, 21 cases of Small-pox were admitted into the Metropolitan Asylums Board Hospitals from this sub-district, of which 4 died. 63 Measles proved fatal only in 3 cases, as compared with 33 in the previous year; but Whooping-cough caused 25 deaths as compared with 15 in the previous year. No death occurred from Scarlet Fever, and none in outlying institutions, though 18 cases were admitted into the Asylums Board Hospitals from Clapham. The persistent decline of Scarlet Fever in the Metropolis, which has continued for more than ten years, has been made the subject of remark by the Registrar General in his Annual Summary; and he suggests as a possible explanation the increasing use of hospitals for cases of this disease, involving as this does, improved isolation. During the year 1878 the proportion of the total deaths from Scarlet Fever which occurred in the Metropolitan Asylums Hospitals was 5 per cent.; in the three years 1879-81 from 7 to 8 per cent.; in 1882 it rose to 9.3, in 1883 to 11.4, in 1884 to 16.4, and finally in 1885 to 19.2 per cent. These figures indicate a steadily increasing use of the Asylums Board Hospitals by those suffering from Scarlet Fever; while at the same time there is a steady decrease of deaths from Scarlet Fever in London. Diphtheria was the cause of 4 deaths in the sub-district, and 2 in outlying institutions; Enteric Fever of 8 in the sub-district, and 2 in outlying institutions. As these diseases appear to be more intimately connected with sanitary defects than others, a special investigation was made in each of the above cases. The result is shewn below. 64 Fatal Cases of Enteric Fever. Place or Death. Remarks. South Hide, Clapham Common. Drains defective and partially choked. W.C. defective. Union Street. Numerous complaints of smell from street grating opposite the house. No defects of house drainage. Chelsham Road. Waste pipe of hath directly connected with soil-pipe. Kitchen sink untrapped. Westbury Street. No Sanitary defects. A doubtful case. Queen's Place, Wandsworth Road. Cause undetected. No sanitary defects in house. Lysias Road. Said by the medical attendant to be a doubtful case, and he subsequently stated it to be scarlet fever. Clapham Park Road. Origin could not be traced. Union Road. Worked at Bromley until taken ill, and died in Stock well Hospital. Pickett Street A doubtful case. Peardon Street. Certificate stated Gastric Fever and Pneumonia; and there is no reason to think the case was true Enteric Fever. Fatal Cases of Diphtheria. Place of Death. Remarks. Beaufoy Road, Wandsworth Road. A doubtful case. Avenue Road, Wandsworth Road. In the scullery, which was used as a living-room, only a bell-trap separated the sink from the drain, and when the trap was removed, there was a powerful up-current and smell. Peardon Street, Wandsworth Road. Cause undetected. Oldridge Road. Cause undetected. Rectory Grove. Cause undetected. Wirtemberg Street. During 15 years in which the house had been occupied by the same family, 12 non-fatal and 1 fatal case of Scarlet Fever had occurred. Also 2 deaths from Diphtheria, and repeated attacks of sore throat. Over £200 had been paid to doctors. From a closet in back-yard ran a pipe drain under the house to sewer. Defective and open joints had already been discovered in this. The rain-water pipe entered it without trapping, and its defective joints ventilated into bedroom windows. On disconnecting the stackpipe, a disused brick drain was discovered, one end of which was connected with the pipe drain and the other ended in a cul-de-sac close to kitchen door. 65 It is not pretended that in every instance where sanitary defects were detected, these were proved to cause the Enteric Fever or Diphtheria. It is usually most difficult to prove the relation of cause and effect. But in the last instance in the table, the prevalence at intervals for nearly fifteen years of Scarlet Fever, Diphtheria, Ulcerated Throats and general ill health, along with defective house drainage leaves little doubt as to the true relation between these. Epidemic Diarrhœa, caused 16 deaths as compared with 18 in the previous year. Deaths from Non-zymotic Diseases. The general table on page 59 details the causes of death and their relative numbers. Respiratory diseases stand at the head of the list, causing 23.6 per cent. of the total deaths (18 per cent. in the previous year); while Nervous diseases caused 15.7 percent. (12.9 in previous year); Tubercular diseases 7.9 per cent.; and Digestive diseases, Developmental and other diseases smaller numbers of deaths. inquests. Nineteen inquests were held during the year, and the following verdicts returned:— 1. From, Natural Causes 9 2. Accidental—Suffocation by over-laying 1 Apoplexy from fall down stairs 2 Concussion from fall down stairs 2 - 5 3. Suicidal—Cut-throat 1 Hanging 1 — 2 4. Homicidal—Cut-throat 1 — 1 5. Open Verdicts—Found drowned 1 Found drowned, probably suicide 1 — 2 Total 19 No uncertified deaths occurred in the sub-district during the year. 66 Sanitary proceedings of the year. During the past year 3,441 houses and premises have been inspected, as compared with 2,270 in the previous year. The thoroughness of this inspection may he gathered from the fact that in 1,517 instances notices required to be served to remedy sanitary defects. In nearly a thousand cases these notices were within a reasonable time complied with; but in 532 instances, secord notices were required; and of these 21 were finally brought before the Magistrate to enforce the carrying out of the necessary work. The investigation of the result of first and second notices required frequent visits of the Inspectors, which are not included in the 3,441 total inspections standing at the head of Table IV. in Appendix. A study of this Table (page 117) will bring out the detailed sanitary work which is being done in this subdistrict. It will be seen that in 1,120 instances syphon traps were fixed to the drains of houses already occupied; 497 sinks and 135 bath and lavatory-wastes were altered to discharge over gullies; 184 rain-water pipes were disconnected from drains; 200 water-closets had a water-supply laid on to them; 261 yards were drained and paved; 203 leaky house-roofs and gutters were repaired; 548 water cisterns were covered and repaired; and 143 cistern overflow-pipes were disconnected from drains. Ten wells were closed, and attention is particularly called to Dr. Muter's weighty remarks at page 109 (which apply particularly to Clapliam). Two hundred and sixty-two "unclassified" nuisances were removed, which included 65 defective waterfittings, 10 closets ventilated or rebuilt, 78 water-closet air pipes removed from inside cisterns, 24 closet windows made to open, 37 ventilating-pipes altered or repaired, 24 new ventilating-pipes constructed to house-drains, &c., &c. 67 All the Bake-houses and Slaughter-houses have been inspected as usual during the past year and found in a good sanitary condition. I have also personally inspected all the Cowsheds in the sub-district, the condition in none of them being such as to justify withdrawal of their licenses. It cannot but be regarded as unfortunate that the Cow-houses and Dairies are supervised by Inspectors of the Metropolitan Board of Works and not of the Local Authority. It is generally acknowledged that Bakehouses have greatly improved in sanitary condition since their inspection was resumed by the Local Authority; and there can be little doubt that the same result would follow if Cowsheds were transferred to the control of the Local Authority. In one respect the change would be especially hopeful. The Inspectors of the Local Authority would be much more likely to know of the existence of Scarlet Fever or similar diseases in the family of those employed in the Dairy, and thus mysterious outbreaks of disease might be prevented. I have in conclusion to congratulate the Clapham Committee on the efficiency of its staff of Inspectors, which leaves nothing to be desired in this respect. Mr. Southam has on all occasions most cordially co-operated with me; and the staff of AssistantInspectors has been greatly strengthened by the appointment of Mr. Dee, who holds honours certificates of competency from the Sanitary Institute and the City ot London Guilds. Mr. Fairchild, the Senior Assistant-Inspector, holds the highest honours and medals of the same Institutions; and I have proved in repeated instances his skill and technical knowledge, as well as his tact and urbanity in dealing with householders. ARTHUR NEWSHOLME, M.D., Medical Officer of Health for Clapham. 68 PUTNEY AND ROEHAMPTON. The very favourable report which I was able to present regarding the health of this sub-district during the year 1884, is excelled in the most unexpected manner by that which I am about to offer upon the public health during the year 1885. Indeed, I think it would be a very hard matter to find any urban or even rural district with so low a death-rate. We have of course the advantage of increasing knowledge of epidemic and other diseases and of the means and modes of meeting them, but on the other hand, we have to face increasing density of population and all the perils of a stupendous sewer system, of which we have the misfortune to be at the fountain-head. It speaks well for the care and energy of the sanitary authorities, as well as for the natural advantages of position, soil, and climate, that a report which can be described as the most favourable ever presented should be in my power to make. Population The growth of London suburbs is such, that the rate of increase which occurred during one decade (say 1871-81) cannot apply to that of the next decade (1881-91), yet for the sake of uniformity and in the absence of an annual census, wo must suppose 69 that it does. The population in the middle of 1885 according to that estimate is 14,830. This is undoubtedly too low. Births and Birth-rate. During the year 1885, 322 children were born in this sub-district, 169 boys and 153 girls. The birth-rate is 21.7 per 1,000 per annum. This rate is undoubtedly very low, being 10.9 under the birth-rate of London and 11.8 under that of the chief towns of England. In poorer neighbourhoods it is not uncommon to get a birth-rate twice as large, shewing that the better classes are either less prolific or more provident. Deaths and Death-rate. The number of deaths known to have occurred during the year 1885 only reached the modest total of 167. Of these 93 were of males and 74 of females. The death-rate is only 11.2 per 1,000 per annum, 8.4 lower than that of London and 9.3 lower than that of the chief towns. In the table below (Table I.) will be found the births and deaths with their rates for the last ten years, and it Will be seen how low the past year stands even compared with our small mortality rates. Only one year (1881) comes near it, the average death-rate being 14.2. There are no towns the death-rates of which are given in the Registrar-General's summary for 1885 with so low a rate. It is an interesting (and to residents or intending residents important) point how far the death-rate of a place may represent the amount of general illness among the population. Unless that deathrate is unduly exalted by the presence of some widespread disease (such as an epidemic) I feel sure for practical purposes that the fatal cases are a very fair means of estimating the state of the public health. This view is borne out by the very uniform number of fatal 70 cases among the non epidemic and non-accidental classes of disease. As a semi-urban and river-side locality, we have a state of the public health more favourable than most rural and elevated districts, and I cannot but think this is partly due to increasing watchfulness on the part of the sanitary authorities over the details of sanitary work (see page 117, Appendix). TABLE I. Birth and Death Rates. YEARS. Births. Birth-rate. Deaths from all Causes. Death-rate. Rate of Natural Increase. 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 1680 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 24 17.1 7.6 1884 377 25.3 199 13.7 11.6 1885 322 21.7 167 11.2 10.4 The rate of natural increase (excess of births over deaths) was 10.4 per 1,000. The following table (II.) gives the deaths tabulated according to their causes, sex, age, and social position. It follows the system of the Registrar-General and is almost identical with that which I have used for some years. Though much abridged from the Registrar's it represents all that is important in the mortality statistics with which we have to deal. 71 TABLE II. PUTNEY AND ROEHAMPTON. Population (Census) 1881 13.221. Official Population in middle of the year 1885 14,830. Total Deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. From 10 to 20 years. 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. CAUSES OF DEATH. I. Zymotic. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 4 3 1 .. 3 1 .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 5 3 2 .. .. .. 1 3 .. 1 .. 1 1 1 2 Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 3 .. 3 .. 2 1 .. .. .. .. .. .. 1 .. 2 Whooping Cough 1 1 .. 1 .. .. .. .. .. .. .. .. .. .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa, Dysentery, and Cholera 4 4 .. 4 .. .. .. .. .. .. .. .. 1 .. 3 Other Zymotic Diseases 1 1 .. 1 .. .. .. .. .. .. .. .. .. .. 1 Totals of Zymotic Class 18 12 6 6 5 2 1 .. .. 1 .. 1 3 1 13 II. Constitutional. Gout and Rheumatism 1 1 .. .. .. .. .. .. .. 1 .. .. 1 .. .. Cancer & Other Tumours 8 4 4 .. .. .. .. 1 1 6 .. .. 5 i 2 Other Constitutional Diseases 2 .. 2 1 .. .. .. .. .. .. 1 .. .. .. 2 Tubercular Phthisis 19 9 10 3 .. 1 1 9 4 1 .. .. .. 5 14 Tabes Mesa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Hydrocephalus 6 2 4 2 3 .. 1 .. .. .. .. .. 1 3 2 Scrofula .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. III. LOCAL. Nervous 26 16 11 15 3 .. .. 2 3 5 .. 1 1 8 16 Circulatory 17 12 5 2 .. .. 2 .. .. 11 1 5 3 3 6 Respiratory 29 14 15 6 .. 1 .. 3 4 8 2 1 2 6 20 Digestive 13 7 6 1 .. 1 • • 2 5 4 .. 1 1 4 7 Urinary 6 4 2 .. .. 1 .. . . 4 1 .. .. 2 3 1 Generative 1 .. 1 .. .. .. .. .. .. 1 .. 1 .. .. .. Locomotory .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumentary 1 .. 1 .. .. .. .. .. .. .. .. .. .. •• .. IV. Developmental. Premature Birth and Low Vitality 6 3 3 6 .. .. .. .. .. .. .. .. 1 3 2 Congenial Defects 3 2 1 3 .. .. .. .. .. .. .. .. .. 1 2 Old Age 7 4 3 .. .. .. .. .. .. 4 3 2 1 1 3 V. Violence 4 4 .. .. .. .. .. 2 2 .. .. .. .. 2 2 VI Ill defined and Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 167 93 74 43 16 6 5 24 25 43 7 12 21 41 93 71 Zymotic or Epidemic Diseases. The amount of epidemic disease which proved fatal in this sub-distaict during 1885 was very small. The proportion of deaths from these diseases was only l.2 per 1,000. There is no single disease which we could say tended to become wide-spread in the community. Diphtheria which had been prevalent in some districts only appeared in isolated cases. Enteric fever was also restricted to the first sufferers. As a district, we are favourably situated to resist invasion of epidemic disease from neighbouring localities. We are isolated from all save Wandsworth, with which our point of contact is limited to one street. The river on the north (an excellent barrier) and open commons on the south and west afford great protection to us from aerial infection. The table below (III.) gives a retrospect of the chief zymotic diseases during the last ten years (76-85). During the past year it will be seen that we have been happily fortunate. TABLE III. Zymotic Mortality in the Putney sub-district. 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 Small-pox 1 .. 1 .. ... •• .. .. 1 .. Measles 1 2 7 .. .. 6 13 2 1 4 Scarlet Fever 3 6 .. 3 1 8 4 7 ., , • Enteric Fever .. 4 1 2 4 1 4 2 10 3 Diphtheria .. 1 1 .. .. 1 29 24 .. 5 Whooping-cough 7 .. 4 8 9 3 8 2 8 1 Epidemic Diarrhoea 7 7 10 7 10 3 5 5 8 4 Other Zymotic Diseases 3 2 12 7 1 5 6 2 .. 1 Total Deaths from Zymotic Diseases 22 22 36 27 25 27 69 44 28 18 Zymotic Death-rate 1.9 1.8 2.9 2.1 1.9 2.0 5.0 3.1 1.9 1.2 Death-rate from all Diseases 13.0 15.0 16.0 15.0 13.6 12.5 15.1 17.1 13.7 11.2 73 Constitutional and Other Diseases. There is nothing of note to mention regarding these classes. Tubercular and respiratory diseases as usual show the unvarying pre-eminence they have obtained in the English climate. They constitute one third of the total deaths from all causes. Many nervous (e.g., convulsions) and other diseases bear a relation to the tubercular class not often noted, and go to show how important a part that deadly disease plays in cutting our lives prematurely short. Table IV. gives the ten years retrospect of the diseases of these classes. TABLE IV. Years. 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 C Gout & Rheumatism .. .. 3 1 4 4 4 5 5 1 Cancer & Tumours .. .. 7 3 6 1 6 8 5 8 Tubercular 26 26 32 23 18 17 12 21 24 25 L Nervous 26 29 28 34 33 21 33 34 39 26 Circulatory 6 8 12 13 13 14 12 14 11 17 Respiratory 23 29 37 42 27 24 29 30 31 29 Digestive 5 12 10 9 13 17 15 15 12 13 Urinary 7 11 2 4 6 2 6 6 10 6 Generative 1 2 .. 1 .. 2 2 4 1 1 Locomotory 1 2 .. .. .. .. .. .. .. .. Integumentary .. 1 .. 2 1 1 1 .. 2 1 D Premature Birth, Atrophy, &c. 10 8 7 8 16 18 7 17 13 9 Old Age 8 8 7 5 9 6 5 10 7 7 V Violence 7 9 5 7 6 13 7 15 11 4 (Other diseases) 1 3 .. .. .. .. .. .. .. 2 Totals 121 148 150 152 152 140 139 196 171 149 Ages of the Deceased. Among young children the mortality of the year 1885 is not so high as in some years and some districts. This is due to the fact that greater care and better surroundings protect infantile life among the well-to-do from those dangers which ignorance, vice, and sometimes crime cause to 74 beset the children of the poor. Still it is too high, for 43 deaths or a percentage of 25.6 of the total deaths occurred among children under one year. Death at the other extreme of life was somewhat heavier still, for 50 persons upwards of 60 years died during the year. This yields a per centage of nearly 30 of the total mortality, of these 31 were 70 years and upwards, of which 15 were males and 16 females. There were 7 upwards of 80, 2 males and 5 females. Social Position The social status of the deceased may be represented as follows:— Nobility and Gentry 7.2 Professional and Merchant 12.6 Middle, Tradesmen, &c. 24.5 Industrial 55.7 100.0 inquests. The number of inquests held in this sub-district during 1885 was unusually small, viz.:—eight. They may be classified according to the verdicts as follows:— I. Natural.—Heart Disease, 1; Acute Peumonia, 1; Syncope, 1 ; and Convulsions, 1. II. Accidental.—Drowning, 1. III. Suicidal.—Hanging, 2 ; Shooting, 1. It is a matter of much satisfaction that only one death from drowning should have occurred during an entire year in our popular stretch of river. It is not unusual to have six or even nine deaths from this cause in a year. From the bridge building and other causes the dangers of the river are at present increased, and so favorable a report would hardly have been expected. Deaths 111 Public Institutions. In 1885, 29 persons died in various public institutions, who claimed on more or less reliable data to belong to this sub-district. Some of these we of course admit as genuine parishioners, viz:—those resident or recently resident in the parish, but persons for years inmates of an infirmary or asylum, or those who have only a casual relation to the district can hardly be allowed to affect our mortality statistics. The following Table (V.) classifies these deaths under the mox-e important causes of death. Three were cases 75 of infectious disease,—Small-pox, Scarlet Fever, and Diphtheria. The first two were removed to the Asylums Board Hospitals, and the last to one of the General Hospitals. The majority were cases of constitutional or local disease, and a large proportion died in the Union Infirmary, where presumably they had spent some time previous to their decease. The total death-rate inclusive of these 29 deaths would be 13.2 per 1,000, and the zymotic mortality 1.4 per 1,000 per annum. TABLE V. Deaths at Outlying Institutions. DISEASE. Sex. Age. Institutions. Total. Male. Female. Under 1. 1 to 60. 60 and upwards. Union Infirmary. General & Special Hospitals. Asylums Board Hospitals. Small-pox 1 1 .. .. 1 .. .. .. 1 Scarlet Fever 1 .. 1 .. 1 .. .. .. 1 Diphtheria 1 .. 1 .. 1 .. .. 1 .. Enteric Fever .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases .. .. .. .. .. .. .. .. .. Tubercular Diseases 5 3 .. .. 4 1 1 4 .. Cancer 2 1 1 .. 2 .. .. 2 .. Rheumatism. .. .. .. .. .. .. .. .. .. Respiratory Diseases 4 3 1 .. 3 1 3 1 .. Circulatory Diseases 4 3 1 .. 3 1 3 1 .. Nervous Disease 6 6 0 .. 4 2 3 4 .. Other Diseases 5 1 4 1 2 2 2 3 .. Violence .. .. .. .. .. .. .. .. .. Totals 29 18 11 1 22 6 11 16 2 76 Sanitary Proceedings. A long and apparently crowded table will be found in the Appendix (page 117) of the Sanitary operations carried out under the Surveyor and Inspector of Nuisances during the year. In many instances the Medical Officer of Health is called upon to assist these officers in their labours and takes a continued and lively interest in their duties. The change of system recently inaugurated of having a personal inspection of the drains of all houses, especially the smaller and more quickly and frequently dilapidated property, has done much good and will do more. Four thousand houses have been inspected during the year,—a number in excess of our total of inhabited houses because several of them have been repeatedly examined—and a variety of defects more or less important revealed. As the wise saying "Take care of the pence and the pounds will take care of themselves" applies to money-getting and keeping; so "Take care of the small defects and the greater ones will find their own remedy" applies to Sanitary work. It is not pretended that this Sanitary inspection is thorough, and it is well the public should be guarded against supposing that any house is perfectly safe because no fault has been discovered. Neither the public purse nor the pockets of the residents are equal to a thorough testing examination (as it means taking up drains, flooring, &c.) but as far as they can be seen and examined without such expense, the sanitary arrangements of the house are examined and the owner or occupier advised upon them. This meets the case in the vast majority of instances, but on (he occurrence of infectious disease a closer inspection is recommended. It is a matter of satisfaction to find that on the whole the inspection is not met in a hostile spirit as an infringement of private rights but is generally and 77 increasingly welcomed as an honest attempt to carry out the intention of all sanitary legislation—the protection of life and health. In most cases the verbal suggestion or first written notice serves to have any defect remedied. First notices were issued to the number of 370, and in all but 15 no second notice was required. Only one case had to be brought to the notice of the magistrate and a compulsory order obtained and complied with. It is but right to say however that many glaring faults were found, which, though detrimental to health, could not be remedied owing to insufficient legislative power. I specially refer to overcrowding, to dilapidations (especially those causing damp), and to bad sanitary apparatus. Regarding the first mentioned, we can only interfere in the case of two families occupying one house and when the total air space of the house is deficient, regardless of the number of people occupying one room say at night or during the day. In the second the wall of a house may be streaming with moisture and the only remedy is to leave the house. In the third case we have no power to abolish pan-closets, D-traps, and bell-traps, though we are convinced that they are usually injurious to health. The removal of Dust is a very important branch of sanitary work. I believe it will never be satisfactorily accomplished until it is done by the Sanitary Authorities themselves. I cannot see why the daily removal of house-refuse at an early hour in the morning could not be accomplished as done in Edinburgh and many other 78 cities and towns. We would not only get rid of the unsightly and often offensive dust cart at all hours of the day in our streets, but could forbid the accumulations of garbage now permitted in the immediate neighbourhood of our houses under the present system of removal. ALEXANDER WALKER, M.D., Medical Officer of Health for Putney Roehampton. 79 STEEATHAM, INCLUDING BALHAM AND TOOTING. It is with great satisfaction that I am enabled to give a very favourable report of the health of this sub-district during the year 1885. The total mortality was considerably below that of the previous year, whilst the death-rate was below the average death-rate of the last ten years. The total mortality from Zymotic diseases was also below the average, and the death-rate from these diseases is only 1.1 per thousand, the lowest recorded during the decade. No death occurred from either Small-pox or Scarlet Fever, nor did any of the diseases in the Zymotic class become at any time epidemic. These facts alone point to a high standard of health, and are sufficient evidence of the care and vigilance of those entrusted with the direction and carrying out of sanitary measures. 80 The following statistics will, I believe, corroborate these observations and shew more fully the state of the public health in Streatham and Tooting during the year 1885. Vital Statistics. Population. According to the official estimate, which assumes an increase of population in the same ratio as obtained in the ten years previous to the last census— the population of Streatham and Tooting in the middle of the year 1885 would be 30,280. I have reason to believe that the population has increased in a higher ratio than prevailed in the decade ending 1881. A large number of new houses have been built since then, and the births have increased in such proportion as to show that there has been a very considerable accession to the population from immigration. This increase is not shown in the official mode of calculation, but it ought to be noticed, as the death-rate is unduly augmented in consequence. Births and Birth-rate. The number of births registered during the year was 1,078 ; 525 were of males, and 553 of females. The birth-rate calculated from the total number of births and the foregoing estimate of the population was 35.6 per thousand persons living during the year, as compared with 39.2 per thousand in the previous year. Natural Increase. The excess of births over deaths represents the natural increase. The excess this year is 717, giving a ratio of 23.6 per thousand of the population. 81 Deaths and The total number of deaths registered Death-rate. during the year was 423, a diminution of 22 on the number registered in 1884. Of these deaths 197 were those of males, and 226 those of females. The death-rate calculated from the total number of deaths, and the official estimate of the population, was 13.9 per thousand persons living during the year. This is below the decennial average, and when the increased density of the population is considered it is a very low one. TABLE 1. Births and Death Rates. YEARS. | Births. Birth-rate Deaths from all Causes. Death-rate Rate of Natural Increase. 1876 536 32.0 260 15.5 16.4 1877 585 34.0 244 12.5 20.0 1878 609 34.4 284 16. 7 18.0 1879 636 34.3 290 15.6 18.7 1880 703 28.1 348 13.9 14.2 1881 830 32.1 313 12.1 20.0 1882 891 33.0 341 12.6 20.4 1883 1,027 36.9 419 14.9 21.5 1884 1,138 39.2 445 15.3 23.9 1885 1,078 35.6 423 13.9 23.6 Deaths in The above record of deaths does not outlying include the mortality amongst those in- institutions. habitants of this sub-district who died in outlying institutions. The subjoined Table gives the additional deaths, with the nature of the cause of death, the age and sex of the patients and the character of the lustitutiou iu which they died. 82 TABLE III. Deaths in Outlying Institutions. DISEASE. Sex. Age. Institutions. Total. Male. Female. Under 1. 1 to 60. 60 and upwards. Union Infirmary. General & Special Hospitals. Asy lums Board Hospitals. Small-pox 2 2 .. .. 2 .. .. .. 2 Scarlet Fever .. .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases .. .. .. .. .. .. .. .. Tubercular Diseases 2 1 1 .. 2 .. .. 2 .. Cancer 4 2 2 .. 4 .. .. 4 .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 3 2 1 .. 1 2 2 1 .. Circulatory Diseases 3 3 .. .. 1 2 2 1 .. Nervous Diseases 8 6 2 .. 3 5 4 4 .. Other Diseases 15 7 8 2 9 4 6 9 .. Violence 1 .. 1 .. 1 .. .. 1 .. Totals 33 23 15 2 23 13 14 22 2 The total deaths in Outlying Institutions were 38. Of these 14 died in the Union Infirmary, 22 in General and Special Hospitals, and only 2 in the Asylums Board Hospitals. If these deaths were added to those actually occurring in the sub-district the death-rate would be increased a little over one (1.2) per thousand. In strict fairness, we ought to be able to deduct from these figures the deaths of those who, although dying in the sub-district, do not properly belong to it. We have however, no means of estimating these deaths. It ought moreover to be noticed that many of the deaths occurring in Public Outlying Institutions are those of persons long resident in such Institutions. These persons may therefore be regarded as non-residents of this sub-district. I am of opinion that, were we in a position to make these two deductions, we should reduce the deaths in Outlying Institutions to one-half. Even under present circumstances our death-rate is a very low one, and compares favourably with that of the healthiest rural districts. 83 STATISTICS OF MORTALITY. STREATHAM, including Total deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. TOOTING & BALHAM. Population (Census) 1881 25,553 Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. From 10 to 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 Labouring Class. Official population in middle of 1885 30,280 CAUSES OF DEATH I. Zymotic. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 2 2 .. .. 1 1 .. .. .. .. .. .. .. .. 2 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 5 3 2 1 3 1 .. .. .. .. .. .. 1 1 3 Enteric Fever 6 3 3 .. 3 .. 1 2 .. .. .. .. .. 4 2 Puerperal Fever 2 .. 2 .. .. .. .. 2 .. .. .. .. .. 1 1 Whooping Cough 7 4 3 3 4 .. .. .. .. .. .. .. .. 5 2 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa, Dysentery, and Cholera 12 5 7 9 2 .. .. 1 .. .. .. .. .. 5 7 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 34 17 17 13 13 2 1 5 .. .. .. .. 1 16 17 II. Constitutional. Gout and Rheumatism 2 .. 2 1 .. .. .. .. .. 1 .. .. 1 1 .. Cancer & other Tumours 11 2 9 .. .. .. .. .. 3 7 1 3 1 3 4 Other Constitutional Diseases 4 2 2 3 .. .. .. .. .. 1 .. .. 1 .. 3 Tubercular Phthisis 43 14 29 4 3 4 4 21 7 .. .. 3 6 10 24 Tabes Mesa 7 4 3 5 1 .. .. 1 .. .. .. .. 1 .. 6 Hydrocephalus 9 7 2 3 2 3 1 .. .. .. .. .. 3 1 5 Scrofula 2 2 .. .. .. .. 1 .. .. 1 .. .. .. 1 1 III. Local. Nervous 61 28 33 17 10 4 1 3 10 14 2 6 8 14 33 Circulatory 26 17 9 1 .. 1 1 5 7 10 1 6 2 8 10 Respiratory 102 49 53 94 17 3 2 7 16 23 10 8 12 31 51 Digestive 33 15 18 7 2 .. 1 1 10 12 .. 4 10 10 9 Urinary 11 7 4 .. .. 2 1 3 2 3 .. .. 1 5 5 Generative 5 .. 5 .. .. .. .. 3 2 .. .. .. 1 2 2 Locomotory .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. IV. Developmental. Premature Birth & Low Vitality 37 16 21 37 .. .. .. .. .. .. .. .. 6 11 20 Congenital Defects 3 .. 3 3 .. .. .. .. .. .. .. .. 1 2 .. Old Age 23 9 14 .. .. .. .. .. .. 10 13 8 2 5 8 V. Violence 9 8 1 1 1 1 .. 2 3 1 .. .. 1 3 5 VI. Illdefined and Illdefined 1 .. 1 .. 1 .. .. .. .. .. .. .. .. 1 .. Not Specified Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 423 197 226 119 52 20 13 51 60 81 27 38 58 123 204 84 Zymotic The total number of deaths in this class Diseases- their was 34, as against 53 in 1884,—17 of these Prevalence were of males, and 17 of females. They and Fatality. yield a percentage of 12.4 upon the deaths from all causes during the year; and give a rate of 1.1 per thousand of the population. This is the lowest death-rate from Zymotic Diseases during the decennium. The death-rate from the principal epidemic diseases for the whole of London was 2.78 per thousand for the year 1885. The following Table contrasts all Zymotic deaths, with the death-rate therefrom, as well as the death-rate from all diseases during the last ten years. TABLE IV. Zymotic Mortality in the Streatham & Tooling Sub-district. 1876 1877 1878 1879 1880 1881 1 1882 1883 1 1884 1885 Small-pox .. 4 1 .. .. .. .. .. .. .. Measles 2 2 11 2 1 3 5 7 8 2 Scarlet Fever 4 1 2 5 31 13 9 2 8 .. Diphtheria 7 3 3 2 7 1 4 13 3 5 Enteric Fever 5 5 I 3 5 2 1 8 4 6 Whooping-Cough 7 6 11 21 8 9 9 11 9 7 Epidemic Diarrhœa 6 4 13 3 6 9 3 9 11 12 Other Zymotic Diseases .. 4 .. 10 10 9 10 15 11 2 Total deaths from Zymotic Diseases .. 29 42 41 68 44 41 65 53 34 Zymotic Deathrate .. 1.7 2.3 2.2 2.7 1.7 1.6 2.3 1.8 1.1 Death - rate from all Diseases .. 12.5 16.7 15.6 13.9 12.1 12.6 14.9 15.3 13.9 This Table shews that the mortality from epidemic diseases was far below the decennial average. In a largely increased population this is very significant, and 85 affords convincing proof of the value of our present mode of isolation and disinfection, in the more formidable diseases of this class. It will be seen from the Table that there was no death from either Small-pox or Scarlet Fever. These are two of the diseases in which such sustained efforts are made to prevent their occurrence and extension. We owe much to isolation in these cases, and the rapid and well-arranged manner in which patients are transferred to Special Hospitals, has proved of signal service, and has, I believe, prevented an epidemic outbreak of Small-pox in this sub-district. This will be very apparent in view of the fact that 20 cases of this disease were sent into Hospital during the year. In saying this, I do not ignore the value of other measures, indeed I place the greatest reliance on the protective influence of vaccination against Small-pox. In this, as in all other infectious diseases, isolation is of the first importance. Moreover the disinfection and fumigation of rooms, clothes, and bedding with sulphurous acid, and the occasional burning of infected clothes and bedding, cannot be too highly rated as preventive measures. Referring again to the Table it shows that there was no death from Scarlet Fever; and only 4 cases were sent into Hospital during the year. Diphtheria had 5 deaths, Enteric Fever 6, Whooping-cough 7, and Diarrhoea 12. None of these diseases compare unfavourably with former years, due allowance being made for altered population. Other Diseaspn. These diseases are grouped in the Mortality Table under six heads, viz:— Constitutional, Local, Developmental, Violence and Illdefined. 86 These diseases in the aggregate shew a diminution on the number recorded in 1884. Separately considered they do not differ very materially from former years. The mortality from Respiratory diseases was high and formed 24 per cent. of all causes of death, as against 15.1 last year. Phthisis Pulmonalis was also unusually fatal, and more deaths took place from old age. The mortality shewed a diminution in circulatory and digestive diseases, as well as in premature births and low vitality. The latter formed 11. per cent. of all causes of death as against 12.5 in 1884. On the whole there is a remarkable correspondence in the number of deaths resulting from the majority of these diseases in the several years of the decade. Age at Death— The mortality in early life was slightly Infant Mortality. below that of 1884,-204 of all deaths occurred before the age of 20. There were 37 deaths from premature birth and low vitality, as against 55 in the previous year. There were but 29 deaths in the Zymotic class as against 41 in 1884. It is very satisfactory to have to record a decided decrease in infant mortality from these diseases, as both classes are largely preventible. Diseases of the organs of respiration and Tubercular affections caused a large proportion of the deaths in early life. 48.2 per cent. of all deaths occurred before the age of 20. 25.7 per cent. were under one year, 40.4 per cent. under five years of age. The infantile death-rate was 110 per thousand. 87 Senile Mortality Twenty-three deaths arose from old age alone, but 108 persons died at 60 and upwards. Of these, 38 were between 70 and 80, 24 were over 80, 4 were 90, and one reached the age of 93. They form 25.5 per cent of all deaths. Of the persons who died at and upwards of 70, 23 were males and 38 females. Sickness and The number of persons who were under Mortality treatment, together with the nature and extent amongst the out-door poor of the Parish. of the sickness that prevailed, and the deaths that occurred among the out-door poor of the parish will be found in Table V. of the Appendix. Two hundred and fifty-four new cases came under treatment during the year. Of these, 32 were in the Zymotic class, as against 56 in the previous year. They include 4 cases of Small-pox, 2 of Scarlatina, 2 of Measles, 14 of Whooping-cough, 8 of Diarrhoea, 1 of Fever, and 1 of Erysipelas, with 1 death from Diarrhoea. The cases of Small-pox and Scarlatina were sent into Hospital. In the other classes there were six deaths. The ratio of deaths to cases treated was 2.7 per cent. Social The following Table gives the percentage of Position. deaths in various classes during the year. Nobility and Gentry 38 = 9.90 per cent. Professional Class 58 = 13.70 „ Middle and Trading Class 123 = 29.98 „ Industrial and Labouring Class 204 = 48.22 ,, 100.00 Total deaths in 1885 423 The Zymotic death-rate was all but nil in the higher classes. In the trading class it formed 37.8 per cent.; and 40.2 in the labouring classes. 88 Inquests. Twelve Inquests were held with the Violent Deaths. following results:- I. Natural Apoplectic Fit 2 Pulmonary Embolism 1-3 II. Accidental Overdose of laudanum 1 Knocked down by engine on line 1 Suffocated in bed 1 Kun over by van 1 Odema of glottis from swallowing carbolic acid 1 Injuries in fall from van 1—6 III. Suicide By shooting 1 By drowning 1—2 IV. Homicide .. Fracture of skull from fall in road having been knocked down 1 12 Uncertified Fourteen deaths were uncertified, they were Deaths. submitted to the Coroner before being registered as having probably died from the following causes:— Convulsions 7 Heart Disease 4 Haemoptysis 1 Senile Decay 1 Premature Birth 1 12 Sanitary A summary of the Sanitary operations of Proceedings. the year will be found in Table IV. of the Appendix. Reference to the Table shews that the systematic house to house visitation of the last few years has been fully maintained in the one under review. Over 5,000 houses and premises were inspected, and 616 first notices were served on owners and occupiers to remedy sanitary defects. Only 15 second notices ware required to-ensure 89 compliance. In no case was it necessary to appeal to the law. The above notices do not nearly represent all the defects discovered on inspection as in a great number of instances they were remedied on requisition. Thirty-two houses were disinfected after infectious diseases by fumigation with sulphurous acid gas, in three instances the clothes and bedding were also burnt. This latter measure is now seldom required and is only resorted to when the bedding, &c., is much soiled and infected. I am glad to report that there has been no recurrence of disease after disinfection in the manner so often described in these annual reports. Eighty-four dilapidated, dirty and unwholesome houses were repaired and cleansed, 508 new drains were laid, 262 untrapped drains had syphon traps affixed, 200 new dust-bins were supplied, and 17 pig nuisances removed. For the figures in respect of new sewers, branch drains, &c., and other sanitary works the reader is referred to the Table. There are 33 bakehouses in the sub-district, they have all been inspected and found in good condition. The cow-sheds and slaughter-houses, 13 of the former and 8 of the latter, have been regularly inspected and are in a satisfactory condition. In May last an important decision was given by Mr. Justice Cave in the case of Ceely & Dunsden v. Neal. The Plaintiffs brought an action to stop brick burning at Park Hill brickfield, Streatham. The Surveyor, the Inspector of Nuisances and myself inspected and reported to the Board on this matter. Mr. Justice Cave in delivering judgment said the evidence satisfied him that so far as the brick burning went there was no nuisance to heaith 96 in the sense of causing disease or illness, but his Lordship said he was satisfied that there was a nuisance which could be perceived at the plaintiffs' premises and to such an extent as to render the occupation of their houses uncomfortable and unenjoyable. His Lordship therefore directed judgment for the plaintiffs, with an injunction to restrain the burning of bricks in a such a way as to interfere with the comfort of the plaintiffs. My thanks are especially due to Mr. Barber for his unvarying courtesy and ready co-operation on any question affecting the health of the sub-district. Mr. Phimister, Inspector of Nuisances, and Mr. Jones the Assistant Inspector have carried out their duties in a very satisfactory manner. F. F. SUTTON, M.D., Medical Officer of Health for Strealham & Tooting. 91 WANDSWORTH. The health of this sub-district during the year 1885 declined considerably from its usually high status. A greater mortality occurred generally from all classes of disease, with few exceptions; diseases of the organs of respiration, including Consumption, and the epidemics, Measles, Whooping Cough, and Diarrhoea, having chiefly contributed to that result. The following statistics, derived from an analysis of the Registrar-General's Returns and of the parochial Records of Sickness and Mortality, will be found on examination to furnish evidence of the foregoing conditions. Vital Statistics. Determined by the official method of calculaPopuiatmn. tion (which assumes the same rate of increase to have occurred during the year under review as that which prevailed during the preceeding ten years), the population of this sub-district at the middle of the year 1885 numbered 31,497. The disproportionately great increase, however, in the number of births that has taken place during the past three years, and especially during 92 the past year (as will be subsequently seen), and the great increase in the number of houses that have been erected during the same period, lead to the conclusion that the foregoing estimate of the population, which does not sufficiently take into account the variable results of immigration, is considerably understated. If such understatement, as may be reasonably inferred, is the case, it should be recognized in the calculation of the death-rate, which by its operation will be correspondingly and unduly raised. Estimated from the proportion which the mean birth-rate bears to the mean population of the decennium 1871—81 (when the population was accurately known), the mean population of 1885 would be about 1,000 higher than the number officially determined. With reference to this subject will be found, in the subjoined footnote, an extract from my annual Report for 1868 (page 14).* The number of deaths registered during the Mortality. past year amounted to 628,—330 of males and 298 of females. The average number of the preceding ten years, raised in proportion to the estimated increase of the population, is 560, and therefore exceeded by 68 in the past year. Of the total deaths 132 took place in the following public institutions, viz.:—in the Surrey County Lunatic Asylum, 105; in the Hospital for Incurables, 7; in * "Looking to the great value which belongs to an accurate determination of Vital Statistics as the first trustworthy step in the projection of Sanitary Science to the prevention of disease, it seems proper to mention that in the Metropolitan suburbs and in large towns known to be greatly increasing by immigration, a more frequent Census of the population is imperatively needed. In such localities, under such conditions, an interval of ten Years, it need scarcely be observed, renders calculation unsound and more or less conjectural. A quinquennial census, with an extended scope of inquiry, might be made the means of conveying most important information alike to the sanitarian and to the political economist. 93 St. Peter's Hospital, 5; in the Prison, 14; and in the Royal Patriotic Asylum for Girls, 1. In addition to the foregoing that took place within the sub-district, 78 deaths of Wandsworth parishioners occurred in outlying institutions, viz.:—54 in the Infimary of the Union and 24 in the Asylum Board and various Metropolitan Hospitals. These are shewn in the following table:— TABLE I. Deaths in Outlying Institutions. DISEASE. Total. Sex. Age. Institutions. Male. Female. Under 1. 1 to 60. 60 and upwards. Union Infirmary. General and Special Hospitals. Asylums Board Hospitals. Small Pox 3 2 1 .. 3 .. .. .. 3 Measles .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. Diphtheria .. .. .. .. .. .. .. .. .. Whooping Cough 1 .. 1 .. 1 .. 1 .. .. Typhus Fever .. .. .. .. .. .. .. .. .. Enteric Fever 1 .. 1 .. 1 .. .. .. 1 Diarrhœa .. .. .. .. .. .. .. .. .. Other Zymotic Diseases. 1 1 .. .. 1 .. 1 .. .. Total Zymotic Diseases 6 3 3 .. 6 .. 2 .. 4 Tubercular Diseases 11 7 4 1 10 .. 8 3 .. Cancer 5 1 4 .. 4 1 2 3 .. Rheumatism 1 .. 1 .. 1 .. .. 1 .. Respiratory Diseases 19 16 4 3 11 5 15 4 .. Circulatory Diseases 6 3 3 .. 2 4 6 .. .. Nervous Diseases 11 5 6 .. 6 6 7 2 2 Other Diseases 17 4 13 1 6 10 14 3 .. Violence 2 2 .. .. 2 .. .. 2 .. Total 78 40 38 5 48 25 54 18 6 94 Death- Calculated from the registered mortality and the rate estimated population, the death-rate of the past year was 19.93 per 1,000 persons living; and, inclusive of the deaths that occurred in institutions without the sub-district, 22.41 per 1,000. Determined, however, in this manner, neither of these deductions can be accepted as representing the natural death-rate of this sub-district, in consequence of the disturbing influence of certain public institutions by the mortality of which the deathrate is unduly raised. These are the Hospital for Incurables, St. Peter's Hospital, and the Surrey County Lunatic Asylum, the inmates of which are, with a fractional exception, derived from without the subdistrict, undergo no natural increase, and are subject to a high mortality, which on an average forms about onefifth of the total deaths registered—an amount that renders any deduction of the death-rate from the death register, without correction for the conditions referred to, entirely valueless. In consequence of the foregoing circumstances, it becomes necessary therefore to deviate from the ordinary method of calculation, and to correct the latter by withdrawing from it the population and mortality of the above-named institutions, and adding to it the deaths of Wandsworth inhabitants that have taken place in hospitals and other institutions located without the sub-district. Calculated in accordance with these conditions, the death-rate of the past year was 19.62 per 1,000. Exclusive of the 24 deaths that took place in the Metropolitan and other hospitals, the rate was 18.82 per 1,000, and admits of more just comparison with the recorded death-rates of former years, which until two years ago did not include those deaths, the latter having always been held to be fully compensated by the deaths of persons who come into the sub-district during the year. 95 Birth The number of births registered during the Birth-rate year was 1,122—571 of males and 551 of Rate of females, and was no less than 171, or more than Natural 15 per cent., in excess of the average of the preincrease. crding ten years. Such a large increase in the number of births clearly indicates a correspondingly large accession to the population by immigration, to which reference has been already made. Calculated from the official estimate of the population, the birth-rate was 37.37, and the rate of natural increase 18.55 per 1,0( 0 persons of all ages. The birth and death rates for ten years are exhibited in the subjoined table:— TABLE II. Birth and Death Rates. Years. Births. Birth-rate. * Deaths from all Causes. Death-rate. Rate of Natural Increase. Corrected. Uncorrected. 1876 679 30.53 461 16.73 19.89 13.80 1877 684 29.90 384 12.59 16.13 17.31 1878 718 30.53 422 14.41 17.26 16.12 1879 744 37.97 516 18.04 20.56 19.93 1880 810 30.53 484 15.45 17.67 15.08 1881 901 33.70 507 17.43 17.97 16.61 1882 972 35.28 544 17.49 18.70 17.79 1883 907 32.07 499 16.17 16.71 15.90 1884 1,072 36.72 576 17.23 18.77 18.81 1885 1,122 37.37 628 18.82 19.93 18.55 * Deaths in Outlying Institutions not included. Causes The following table contains a nosological of Death. classfiication of all the causes of death, distinguishing the several diseases of the Zymotic class, and shewing the sex, age at death at eight periods, and the social position of the deceased persons: — 96 TABLEAU/. STATISTICS OF MORTALITY. WANDSWORTH. Total Deaths from each class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Population (Census) 1881 28,00 Official Population in middle of 1885 31,497 CAUSES OF DEATH. Males. Females. Under 1 year. From 1 to 5 years. From 6 to 10 years. From 10 to 20 years. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 yoars j of age. 80 years and upwards. j Nobility and Gentry. Professional Class Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. I. Zymotic. Small-pox 3 .. 3 1 1 .. .. 1 .. .. .. .. .. 1 2 Measles 19 13 b 1 17 1 .. .. .. .. .. .. 1 1 17 Scarlet Fever 3 2 1 .. 1 1 .. 1 .. .. .. .. .. 1 2 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 4 2 2 .. 2 .. .. 2 .. .. .. .. .. .. 4 Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 6 4 2 1 2 2 .. .. 1 .. .. .. .. .. 4 Whooping Cough 24 11 13 10 13 1 .. .. .. .. .. .. 1 4 19 Erysipelas 3 1 2 1 .. .. .. .. .. 2 .. .. .. .. 1 Diarrhœa, Dysentery, and Cholera 35 18 17 29 4 .. .. .. .. 2 .. 1 2 6 26 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 97 51 46 43 40 5 .. 4 1 4 .. 1 4 17 75 u. Constitutional. Gout, and Rheumatism 6 3 3 .. .. .. 1 2 2 1 .. .. 1 2 3 Cancer & other Tumours 21 7 14 .. 1 .. .. 4 13 3 .. 2 2 4 13 Other Constitutional Diseases 1 .. 1 .. .. .. .. .. 1 .. .. .. .. 1 .. Tubercular Phthisis 67 36 31 2 b 1 9 27 15 1 .. 3 6 17 41 Tabes Mesa 12 7 5 10 2 .. .. .. .. .. .. .. 1 5 6 Hydrocephalus 8 3 6 3 3 1 1 .. .. .. .. .. 1 2 5 Scrofula 3 3 .. 1 .. .. 1 .. 1 .. .. .. .. 1 2 III. Local. Nervous 145 79 66 19 15 .. 2 25 48 34 2 1 6 46 92 Circulatory 36 12 24 .. .. .. 2 7 7 19 1 4 2 13 17 Respiratory 101 57 44 2b 27 2 1 7 lb 20 .. 1 2 24 74 Digestive 22 8 14 3 .. 1 1 3 V 7 .. 3 .. 7 12 Urinary 12 9 3 .. 1 .. .. 1 4 6 .. 3 .. 4 5 Generative 6 1 5 .. .. .. 1 2 3 .. .. .. .. .. 4 Locomotory 2 .. 2 .. .. .. .. 1 1 .. 1 .. 1 .. Integumentary 3 2 1 2 1 .. .. .. .. .. .. .. .. .. 3 IV. Developmental. Premature Birth and Low Vitality 34 22 12 34 .. .. .. .. .. .. .. .. .. 6 28 Congenital Defects 3 2 1 3 .. .. .. .. .. .. .. .. .. .. 3 Old Age 34 15 19 .. .. .. .. .. .. 20 14 1 1 7 25 V. Violence 15 13 2 2 3 .. 1 5 3 1 .. .. .. 1 14 VI. Ill-defined and Ill-defined .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Not specified Not specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 628 330 298 148 99 10 20 87 122 123 19 20 26 160 422 97 Diseases of the Brain and Nervous System caused, as usual, by far the largest number of deaths registered, amounting to 145, or upwards of 23 per cent. of the whole; but more than 72 per cent of these deaths occurred in the Surrey County Lunatic Asylum, and, except from the circumstance of being registered in Wandsworth, do not properly belong to this sub-district. Excluding this class of diseases for the reasons already given in reference to the determination of the death-rate, the following are the numerical proportions borne by the several classes of disease in the causation of mortality. Diseases of the Organs of Respiration contributed the largest number, amounting to 16 per cent. of the whole; diseases of the Zymotic class formed the next largest number of 15 per cent.; following in numerical order of fatality, the Tubercular class of diseases (three-fourths of which where due to Consumption) formed 14 per cent.; other Constitutional diseases of this class (which in former reports were grouped under the head of Cancer, Dropsy, and of uncertain seat), 4.4 per cent.; diseases of the Organs of Circulation (Heart, &c.), 5.7 per cent.; Premature birth, &c., 5.4 per cent.; Old age, 5.4 per cent.; diseases of the Digestive Organs, 3.5 per cent.; Violence, 2.4 percent.; Urinary diseases, 1.9 percent. The most fatal single disease was, as usual, Consumption, which formed 10.6 per cent., and was closely approached by Bronchitis. The greater or less fatality that resulted from the several classes of diseases during the past year in comparison with that of the preceding ten years and their averages, is shewn in the two following tables, the first of which compares the Non-zymotic and the second the Zymotic Diseases. Although the essential fluctuations both in number and kind, will be found to be presented, as is invariably the case, by diseases of the Zymotic class, a greater variation than usual is observable in the table 98 of general or non-zymotic diseases, all the causes of death, except diseases of the Digestive and Urinary Organs and Violence, being greatly in excess. TABLE IV. Non-zymotic Mortality. Causes of Death. 1876. 1877. 1878. 1879. 1880. 1881. 1882. 1883. 1884. 1885. 1885. No. above corrected average. No. below corrected average. Constitutional Tubercular 64 54 60 62 60 51 69 64 85 90 15 .. Other Constitutional 18 17 14 12 17 19 19 20 18 28 8 .. Nervous 125 111 111 96 106 121 106 116 128 145 16 .. Local. Circulstory 26 21 19 20 23 28 28 25 22 36 7 .. Respiratory 58 42 86 125 89 90 87 69 70 101 13 .. Digestive 29 18 29 21 21 28 28 35 47 22 .. 9 Urinary 6 9 4 10 11 4 20 13 15 12 .. 1 Generative 2 3 4 10 1 .. 4 .. 3 6 3 .. Locomotory .. .. 1 .. 3 2 1 .. 2 2 1 .. Integumentary .. .. .. .. .. .. 1 .. .. 3 3 .. Developmental. Premature Birth Malformation 22 19 18 18 27 37 27 23 40 37 5 .. Low Vitality Age 16 13 14 26 23 27 27 33 42 34 6 .. Violence 14 11 13 11 11 20 18 32 21 15 .. 3 Not specified 1 3 1 1 .. 4 1 .. .. .. .. 1 Zymotic Mortality. The following table exhibits the total Epidemic Diseases, deaths that occurred from Zymotic Distheir prevalence eases, specifying those that resulted from and fatality 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:— 99 TABLE V. Diseases. 1875. 1876. 1877. 1878. 1879. 1880. 1881. 1882. 1883 1884. 1885. 1885. No. above corrected average. No. below corrected average. Seven principal Epidemic Diseases. Small Pox 1 1 .. .. 1 .. 9 .. .. 1 3 2 .. Measles 2 17 .. 4 16 9 5 18 14 6 19 9 .. Searlet Fever 5 12 21 2 15 24 19 9 5 5 3 .. 11 Diphtheria 2 1 .. 4 1 4 1 3 11 4 6 3 .. Fever Typhus Euteric 5 12 9 3 8 6 4 9 12 4 4 .. 4 Whooping Cough 14 10 11 6 44 15 12 26 5 17 24 6 .. Diarrhoea 17 16 16 19 7 20 19 29 10 27 35 14 .. Cholera .. 2 .. .. .. .. .. .. .. .. .. .. .. Total Deaths from above Epidemic Diseases 46 71 57 38 92 78 69 94 57 64 94 16 .. Other Zymotic Diseases 10 9 6 10 12 14 7 14 20 19 3 .. 12 Total Deaths from Zymotic Diseases 56 80 63 48 104 92 76 108 77 83 97 .. .. Zymotic Deathrate per 1,000 2.48 3.45 2.64 1.96 4.14 3.35 2.71 3.72 2.57 2.70 3.07 Total Deaths from all causes 420 461 384 422 516 484 507 544 499 576 628 68 .. Per centage of Deaths from Epidemics to Deaths from all causes 10.9 15.4 14.8 9.0 17.8 16.1 13.6 17.2 11.4 11.1 14.9 Of the 97 deaths that resulted from the above diseases, 94 were of the epidemic (or infectious) kind, and exceeded the average of the preceding ten years corrected for increase of population by upwards of a fifth part. This excess was principally due to Measles, Diarrhoea, and Whooping Cough, the two first of which diseases exceeded their average fatality by one-half, and the third by a third part. Diphtheria was in excess by one-half, but Scarlatina shewed a diminution of three-fourths, and l00 Fever of one-half of their respective averages. There were three deaths only registered from Small Pox, but three more occurred in hospital, the average being exceeded by two. In the calculation of the foregoing averages the deaths in hospitals have been included. The propagation of infective diseases by the return to school of children during convalescence from these diseases, with the remedies suggested for its prevention, has been so recently explained as to require no further comment here, than that the evil is one of great extent and importance, and therefore deserving serious attention. (See Report 1884, page 92.) The months in which the deaths from Epidemic Diseases occurred, with the mean temperature of each quarter of the year, are shewn in the subjoined table. The bulk of these deaths will be seen to have occurred in the Spring and Autumn quarters, the amount in each of which was more than twice as great as in the Summer quarter, and more than five times as great as in the Winter quarter. The cause of such difference is not apparent by a consideration of the climatic conditions of the year. TABLE VI. DISEASE. J anuary February March April May June July August September October November December Mean Temp. 40.3 Mean Temp. 52.4 Mean Temp. 59.1 Mean Temp. 42.8 Small Pox 2 .. .. .. 1 .. .. .. .. .. .. .. Measles 2 2 6 2 4 .. .. .. 1 .. 1 1 Scarlatina .. 2 .. .. .. .. .. .. .. .. 1 .. Diphtheria 1 .. .. 1 .. .. 1 i 1 1 .. Whooping Cough 4 2 7 6 3 .. .. 2 .. .. .. 1 Diarrhœa 2 .. 2 .. .. .. 5 19 5 1 1 .. Fever .. 1 1 1 .. .. .. 1 .. .. .. .. Totals 11 7 16 9 8 .. 6 23 7 2 3 2 34 17 36 7 101 Deaths in relation to Social Position. The following table represents the relative proportions of the total deaths, as well as of the deaths from Zymotic Diseases, borne by the several classes of the inhabitants:— TABLE VII. Social Position. Total Deaths. Deaths from Zymotic Diseases. 1886. Decennial Average. 1885. Decennial Average. Nobility and Gentry 3.18 3.53 1.03 1.13 Professional Class, Merchants, Banters, &c. 4.14 5.19 4.12 4.37 Middle & Trading Classes, Clerks, &c. 25.48 20.60 17.53 19.25 Industrial and Labouring Classes 67.20 70.68 77.32 74.75 100 .00 100.00 100 .00 100. 00 The gradual reduction in the relative amount of mortality borne by the labouring classes, which has been noticeable for many years, is seen to have continued in the past year, as regards the total amount, to the extent of 3.48 per cent.; but, as might be anticipated from the greater fatality that occurred from infective diseases, which are always found to afflict those classes with greatest severity, the amount of Zymotic mortality suffered by them exceeded the average by 2.57 per cent. Vaccination. In the annual Return of the Vaccination Officer to the Local Government Board specting the vaccination of children whose births occurred in 1884, it appears that of 1,063 children born 939 were successfully vaccinated, 3 were returned as "insusceptible," 67 died unvaccinated, and 3 were postponed on account of sickness, leaving 51, or 4.7 per cent., who had removed to places unknown or which could not be reached. 102 This result, compared with that of the whole Metropolis, in which (according to the last Return) the residue of children unaccounted for was 6.6 per cent., is very satisfactory. Age at Death. Infant Mortality. As a consequence of the greater fatality from diseases of the Epidemic kind during the past year, the deaths of children shew a considerable increase. The deaths of infants under one year of age formed 23.5 per cent of all deaths, the decennial average having been 22.4 per cent.; of children under 5 years of age, 39.3 per cent., the average having been 35.5 per cent.; while the total deaths under 20 years of age were of average amount. Calculated from the number of registered births, the rate of mortality of infants under one year of age was 13.1 per cent., and agreed almost exactly with the average. Senile Mortality. The number of deaths at high ages was eight less than in the year preceding. Seventy-one were registered at 70 years of age and upwards, 34 of which were recorded as having resulted from old age unconnected with disease. The great majority consisted as usual of females. The number, age, and sex of the deceased are subjoined:— TABLE VIII. Age. Males. Females. Total. 70— 75 12 24 36 75 — 80 6 12 18 80 — 85 4 5 9 85 — 90 3 3 6 94 . . 1 1 96 1 . . 1 26 45 71 103 Sickness and Mortality of the Parochial Poor. Table III. in the Appendix contains the amount, nature, and fatality of the sickness that occurred amongst the parochial poor during the year. It will be there seen that 643 fresh cases of disease came under treatment, resulting in 32 deaths, or a little less than 5 per cent.; and 94 cases of infectious disease, 9 of which terminated fatally. Measles, Diarrhoea, Scarlatina, and Small-pox were the most prevalent Epidemics; of the last named disease there were 28 cases, all of which were removed to the Asylums Board Hospitals, where 3 ended fatally. There were 8 cases only of Whooping Cough, and 2 of Fever. While the total sickness and mortality was of average amount, that portion attributable to Zymotic disease considerably exceeded the average, thus corroborating the figures in Table VII. (page 101), which shews the relative mortality of the several classes of the inhabitants. Inquests. Violent Deaths. Uncertified Deaths. Thirty-five inquests were held during the year, or three more than in the year preceding; the deaths from violence were 17, or two less. The number of uncertified deaths was 8 only, and although 9 less than in the previous year, were still so many cases in which, in the absence of skilled testimony, death may have resulted from other than natural causes. As has been repeatedly urged in these Reports (see that for 1865 and following), it is imperatively necessary, in the interests of society, that there should be a medical investigation in every case in which the cause of death has not been duly attested by a registered medical practitioner. The number and sex of the persons that formed the subjects of inquiry, with the result of the latter, are summarised in the following table:— 104 TABLE IX. Males. Females. Total. Deaths from natural causes 15 3 18 Deaths from violence, viz.:— Accidental Wound of Wrist 1 11 Choked by Food 1 1 Drowning 3 — Knocked down by Locomotive 1 — Hemorrhage 1 — Suffocation 2 — Run over by Horse & Cart — 1 Suicidal Drowning 1 — 3 Cut-throat 2 — Homicidal Manslaughter 1 — 2 Execution 1 — Not specified Found dead in Thames. 1 — 1 29 6 35 Sanitation. All the usual sanitary operations (the most important of which will be found enumerated in Table IV. in the Appendix) were carried out with unabated activity. In addition to ascertaining the existence of nuisances, and the investigation of such as formed the subjects of complaint, the inspecting of houses (all classes) and recording their sanitary condition, with the removal of ascertained defects, have been systematically pursued as a daily routine; by a reference to the table it will be seen that no less than 4,350 houses have been so dealt with during the year. As an indication of the extent of these inspections, it may be observed that at the census of 1881 the number of inhabited houses (although they have considerably increased since that period) was 4,255. The process of disinfection and purification of houses after Epidemic diseases have been perseveringly employed,—immediately in the case of a 105 patient removed to hospital, or, if not removed, as promptly as the condition of the patient or other circumstances allowed. It was employed in 112 houses, and in 5 only, which were infected by Small-pox, was there what is termed in the table a recurrence of the disease. Such a designation of subsequent cases, however, is scarcely correct, inasmuch as the interval between the period of disinfection and the occurrence of another attack in the same house, in every instance except one, was less than 12 days—the period of incubation, or that within which the patients could have been affected before disinfection was first employed; and in the exceptel case the interval was four months and a half—a length of time which would make the probability of recurrence extremely doubtful. Judged by the results recorded for several years, disinfection, as carried out iu this subdistrict, must be admitted to have been attended with marked success. Nevertheless, doubts have been expressed as to the propriety of employing disinfection after Measles and Whooping Cough, in consequence of the circumstance that such procedure has not been generally adopted in other Sanitary Districts. I would therefore bag to point to the great infectiveness of these diseases, particularly of Measles, and their great destructiveness of infant life, as well as to the general principle involved in the duty of preventing the spread of infective diseases of employing all reasonable measures for the attainment of that end, as a sufficient justification for my recommendation of the adoption of disinfection after those diseases. "The mortality of Measles," as stated in one of my fortnightly reports, "is twice as great, and that of "Whooping Cough three times as great, as that resulting "from Small-pox." By a reference to the RegistrarGeneral's "Annual Summary" for 1885, page 24, it will 106 be seen that the annual average number of deaths in the Metropolis during the ten years 1875 —84, from Smallpox was 1,038, from Measles, 2,236, and from Whooping Cough, 3,260. In support of the procedure adopted in this sub-district I would refer to the opinion of that eminent authority, Dr. Buchanan, the Medical Adviser to the Local Government Board, thus expressed: "I should unquestionably "rank Measles among the diseases that people should "strive to control by the use of atmospheric disinfectants "as well as by ordinary methods of ventilation and "cleansing. The disease is indeed one that is particularly "apt to spread through the air from person to person, "and any measures for destroying its infectiveness should "certainly be applied, among other ways, to the atmo" sphere of infected houses." The simple, cheap, and effective application of sulphur fumigation against the spread of infective diseases, is, without doubt, one of the most successful of all the sanitary operations of the Board, and cannot, it is submitted, be dispensed with in reference to Measles without disregarding the security of infant life. In addition to the proceedings set forth in the table, all the bakehouses in the sub-district have been periodically inspected, and the slaughter-houses and cow-houses, as usual, examined and their condition reported as satisfactory previous to the granting or renewal of their owners' licenses. Many serious nuisances, also, that formed the subjects of special Reports, were dealt with, the details of which occupied much time and attention in their disposal, such as the pollution of the River Wandle and Boundary ditch by the sewage from the farm of the Croydon Rural Sanitary Authority; the 107 introduction into the main sewer of the products of gas manufacture; the fur-dyeing factory nuisance; brickburning and other causes of nuisance at the Osiers, Riverbank; several piggeries, &c., &c. Altogether, the accomplishment of a vast amount of sanitary work has been effected during the past year by the Sanitary Inspectors, whose zeal and assiduity in the performance of their important duties are deserving of highly favorable comment. The result of such work has been productive of a great amelioration in the sanitary condition of the sub-district, and such improvement would be greatly extended by the accomplishment, inter alia, of the suppression of piggeries within the precincts of the town; the prevention of aerial pollution from sewer-gases by the employment of an abundant supply of water for drainage purposes; and by the prompt and systematic removal of house refuse (by means of portable utensils),—measures long advocated in these Reports. (See Reports, 1878, page 66; 1866, page 17; and 1856, page 24.) GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsworth. 109 ANALYST'S REPORT. To the Wandsworth Board of Works. Gentlemen, For the purposes of incorporating a record of the work done in your District under the "Sale of Food and Drugs Act" with the annual statement of the Medical Officers of Health, I beg to report as follows:— (1) As to the Food supply.—During the year ending April 1st, 1886, I have received from the Inspector 400 samples for analysis. The articles were various and well selected, and covered all the chief substances commonly sold by the purveyors of the District. It is a satisfactory circumstance to record that, of all these articles, I could only charge 11 as being below the recognized limits of commercial purity. These 11 articles were made up as follows:— Milk 9 Gin 1 Butter 1 11 The excellent effect of your policy of continuous special inspection is therefore strongly evident in the above recorded state of the food supply, which maintains, as heretofore, its high state of purity. (2) As to the Water supply.— Some few of the residents in the District still obstinately stick to the use of wells instead of laying on the Company's water, and, during the year, I have received and analysed 34 samples from local pumps. All have been found to be questionable and some actively dangerous. On this point the public cannot be too strongly warned that water drawn from a town soil, perforated in every direction with sewers and gas pipes, and long since denuded of the bulk of its natural carbonate of lime, is continually altering in its nature for the worse, and is a most undesirable source of 110 domestic supply. Although a Medical Officer, on considering the Analyst's results, very often cannot put his hand down and assert that a certain water is, at the moment, actively dangerous to health, yet he can see that it is merely surface water, and that it only requires a start to become at once a focus for the dissemination of disease. Here your Officers are often placed in a delicate position, because, although they may perfectly clearly see that such water should be shunned, yet they cannot go into Court on a theory of what might happen, but only on what is actually present at the moment, and thus some obstinate people may go on daily courting danger. The residents should be made aware that all the well waters of the District are more or less undesirable, and that it is exactly the refreshing flavour they so much admire which is one of the danger signals. The local wells are mostly practically charged only with sulphates and nitrates, and the latter, while giving the cooling taste so relished by the owners, are (except in Artesian wells) nothing more than the representatives of previous contamination, and the indication that what has occurred before may very readily do so again. If this plain warning, from a perfectly unprejudiced person, be taken by some of the persons who at present continue to nurse the serpent likely to bite them in the future, it will be a considerable aid to the exertions so ably made by your Medical Officers to secure a high standard of health in your District. (3) Use of the Act by the Public.—During the year two persons have taken advantage of the provisions of the Act by obtaining analyses of milk at the statutory fee. I have the honor to be, Gentlemen, Your obedient servant, JOHN MUTER, Ph.D., F.I.C., F.C.S., Public Analyst. 111 APPENDIX OF STATISTICAL TABLES. 112 TABLE I. Summary of Deaths and their Causes, registered in the entire District during 1885, classified according to Sex, Age, and Social Position, and showing also the relative numbers in each Sub-district. POPULATION of entire District, (Census) 1881, 210,434. Official Population in middle of 1885, 248,410. Area in Statute Acres, 11,695. Total Deaths from each class of Disease in the entire District. Sub-Districts. Sex. Age. Social Position. East Battersea—Population, 66,654. Area in acres, 947, West Battersea—Population, 64,317. Area in acres, 1,396. Clapham—Population, 40,832. Area in acres. 1,233. Putney—Population, 14,830. Area in acres. 2,176. S treat bam, Tooting and Balham—Population. 30,280. Area in acres, 3,465. Wandsworth—Population, 31,567. Area in acres, 2,478. Males. Females. Under 1year. From 1 to 5 years. From 5 to 10 years. From 10 to 20 years. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c Middle & Trading Class, Shopmen, Clerks,&c Industrial and Laboring Class. CAUSES OF DEATH. 1. Zymotic. ("Small Pox 5 1 1 ... ... ... 3 1 4 1 1 ... 2 1 ... ... ... ... ... 1 4 Measles 140 49 63 3 4 2 19 72 68 18 108 13 1 ... ... ... ... ... 1 10 129 Scarlet Fever 11 3 5 ... ... ... 3 6 5 ... 7 2 1 1 ... ... ... ... ... 3 8 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 41 9 9 8 5 6 4 21 20 1 11 ... 11 16 1 1 ... 1 5 10 25 Puerperal Fever 23 8 10 3 ... 2 ... ... 23 ... ... ... 2 21 ... ... ... ... ... 4 19 Diphtheria 28 8 2 4 3 5 6 12 16 3 18 6 ... ... 1 ... ... ... 3 6 19 Whooping Cough 178 47 74 25 1 7 24 85 93 82 91 4 1 ... ... ... ... ... 4 23 151 Erysipelas 17 5 7 2 ... ... 3 9 8 4 ... ... 1 3 3 6 ... ... ... 3 14 Diarrhoea, Dysentery, & Cholera 193 63 63 16 4 12 35 106 87 161 15 3 2 5 7 ... 1 5 31 156 Other Zymotic Diseases 1 ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 Totals of Zymotic Class 637 193 234 62 18 34 97 313 324 271 251 25 22 44 10 14 ... 2 19 93 533 II. Constitutional. "Gout, and Rheumatism 32 11 9 3 1 2 6 17 15 1 ... ... 3 10 7 11 ... 1 4 12 15 Cancer and other Tumours 105 18 31 16 8 11 21 31 74 ... 3 ... ... 9 49 41 3 7 11 18 69 Other Constitutional Diseases 23 7 8 1 2 4 1 11 12 11 2 ... 1 3 2 3 1 ... 3 2 18 Tubercular Phthisis 406 91 138 48 19 43 67 196 210 18 17 11 50 174 124 12 ... 12 22 78 294 Tabes Mesa 159 62 71 7 ... 7 12 90 69 131 21 1 1 3 1 1 ... 1 3 22 133 Hydrocephalus 69 27 9 10 6 9 8 30 39 26 31 9 3 ... ... ... ... ... 7 10 52 Scrofula 30 1 21 3 ... 2 3 10 20 12 10 1 3 2 l 1 ... 1 1 6 22 III. Local. Nervous 594 104 178 80 26 61 145 310 284 154 72 16 16 50 120 146 20 17 29 145 403 Circulatory 278 51 108 40 17 26 36 130 148 11 1 1 14 39 78 121 11 25 17 67 169 Respiratory 982 303 327 120 29 102 101 504 478 293 226 16 8 62 152 199 26 17 32 155 778 Digestive 186 36 52 30 13 33 22 82 101 31 7 9 4 19 60 59 3 12 19 58 97 Urinary 81 16 30 6 6 11 12 50 31 2 2 4 1 8 32 30 2 6 5 24 46 Generative 42 7 16 7 1 5 6 2 40 1 ... ... 2 21 13 4 1 1 2 10 29 Locomotory 11 3 5 1 ... ... 2 3 8 2 2 1 ... ... 2 4 ... 1 ... 2 8 Integumentary 9 1 4 ... 1 ... 3 3 6 4 1 1 ... 2 1 ... ... ... ... ... 9 IV. Developmental. Premature Birth, Low Vitality and Congenital Defects 259 82 55 36 9 40 37 148 111 257 2 ... ... ... ... ... ... ... 12 48 199 171 22 54 31 7 23 31 63 108 ... ... ... ... ... 2 85 84 13 11 33 114 V. Violence 97 32 29 8 4 9 15 64 33 39 8 ... 3 16 22 6 1 ... 1 16 80 VI. Illdefined & notspecified 20 4 15 ... ... 1 ... 12 8 4 1 ... ... 4 7 4 ... ... ... 3 17 Illdefined not sp'fd. 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 Totals 4192 1071 1395 50 167 423 628 2069 2123 1268 659 94 131 467 683 740 150 116 196 802 3078 113 TABLE II. Showing the total number of deaths and their causes registered in the entire District, during the eleven years 1875-85, with the relative numbers of each class of disease. DISEASES, And other causes of Death 1875 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 Classes: 1 Zymotic Small Pox 3 26 57 19 4 3 37 1 .. 9 5 Measles 27 88 64 84 125 59 134 115 133 182 140 Scarlatina 134 86 58 39 134 173 100 119 65 47 11 Diphtheria '28 15 7 19 17 19 18 51 63 43 29 Whooping Cough 107 126 73 149 148 123 105 163 133 145 178 Typhus and other fevers 39 47 64 39 62 44 37 49 52 58 41 Diarrhœa & Choleraic Disease 134 159 114 182 94 213 149 117 158 239 193 Erysipelas 24 13 13 5 13 10 15 18 10 28 17 Metria, Childbirth 15 26 20 7 28 23 29 19 25 24 23 Carbuncle .. .. .. .. .. .. .. 3 .. .. Influenza .. .. 1 .. .. .. .. .. .. .. .. Quinsy .. ... .. 1 .. 1 .. 1 .. .. .. Group 26 27 20 39 40 19 18 31 60 38 .. Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. 1 Totals of Zymotic Class 537 613 491 583 665 687 642 687 699 817 638 2. Grout and Rheumatism 11 14 13 15 8 15 25 25 25 24 32 3. Cancer & other Tumors 105 97 101 106 91 110 118 144 114 148 105 4. Other Constitutional Diseases .. .. .. .. .. .. .. .. .. 23 5. Tubercular Diseases 565 555 514 501 513 625 557 521 654 715 664 6. Nervous 455 316 450 503 474 464 540 539 574 602 594 7. Circulatory 176 170 204 212 203 193 245 251 255 269 278 8. Respiratory 630 561 519 694 891 657 695 850 829 758 982 9. Digestive 136 126 155 150 117 155 208 195 234 227 186 10. Urinary 55 62 63 42 74 66 70 89 99 80 81 11. Generative 13 23 29 19 25 20 35 32 30 35 42 12. Locomotory .. .. .. .. .. .. .. .. .. .. 11 13. Integumentary 4 5 6 1 3 8 3 9 10 3 9 14 Premature Birth, Low Vitality, Mal- formation, &c. 177 226 212 177 170 266 232 234 241 304 259 15. Old Age 130 150 126 141 141 136 120 153 185 154 171 16.Violence 68 90 82 75 83 96 113 104 94 111 97 17. Ill Detined and Not Specified 34 46 25 56 68 95 44 18 40 19 21 Totals 3096 3154 2991 3275 3526 3593 3647 3851 4083 4266 4193 114 TABLE III. 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, 1885. Compiled from the District Medical Relief Books. SUB - DISTRICTS. Total Cases of Sickness treated in each Sub-District. Total Deaths in each Sub-District. 1—Small Pox. 2—Measles. 3—Scarlatina. 4—Diphtheria. 5—Whooping Cough. 6—Diarrhoea and Dysentery. 7—Cholera. 8—Fever. 9—Erysipelas. 10—Puerperal Fever. 11—Lung Disease except Phthisis. 12—Phthisis. 13—Hydrocephalus, Atrophy, Scrofula and Infantile Convulsions 14—Violence, Privation, and Premature Birth 16—Other Diseases. Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases s Battersea East 1008 28 103 .. 23 .. 12 1 1 .. 5 .. 19 2 .. .. 8 1 4 .. .. .. 153 12 24 4 3 1 13 .. 640 7 West 609 29 44 .. 18 1 7 .. 15 1 11 .. .. .. .. .. 7 .. 9 .. .. .. 153 13 7 6 7 3 18 .. 313 5 Clapham 5S7 19 12 .. 5 1 11 .. .. .. 8 .. 20 2 .. .. 2 .. 3 .. .. .. 142 10 23 4 .. .. 20 .. 341 2 Putney and Roehampton 117 5 .. .. 10 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 24 1 6 2 .. .. 4 .. 65 2 Streatham including Tooting and Balham 254 7 4 .. 2 .. 2 .. .. .. 14 .. 7 .. .. .. 1 .. 1 .. .. .. 35 1 3 2 1 .. 3 3 184 .. Wandsworth 643 32 28 .. 22 3 13 2 .. .. 8 .. 27 3 .. .. 2 .. 5 1 .. .. 166 9 2 2 6 2 .. .. 339 9 Totals 3218 120 191 .. 80 5 35 3 16 1 46 .. 73 7 .. .. 21 1 22 1 .. .. 673 46 65 20 7 6 58 3 1882 25 The ratio of deaths in cases treated is 3.7 per cent. 115 TABLE IV. Summary of Sanitary Operations in the entire District during the year 1885. East Battersea. West Battersea. Clapham. Putney. 1 Streatliam. Wandsworth Total. Number of Houses & Premises inspected 8111 8460 3441 3997 5055 4350 33414 1st Notices served 617 1000 1517 370 616 608 4728 2nd Notices served 188 203 532 15 15 58 1011 Number of houses disinfected after infectious diseases 257 169 52 13 32 112 635 Number of houses in which infectious disease recurred after disinfection .. .. .. .. .. 5 5 Number of houses from which bedding, &c., was burnt .. 3 33 .. 3 2 41 Disinfecting apparatus at Putney, number of times used .. .. .. 8 .. .. 8 Overcrowding abated 11 3 5 3 3 .. 25 Rooms cleansed and repaired 65 8 376 17 39 24 529 Staircases & passages cleansed and repaired 25 2 63 4 .. 9 103 New drains and drains relaid 626 327 141 508 84 1686 Number of feet of new sewers and branch drains 21933 2516 3326 15967 7576 51318 Drains cleansed and repaired 596 188 214 92 153 97 1340 Syphon traps fixed to drains 107 155 1120 .. 262 1 1645 Sinks altered to discharge outside o\er gullies 39 34 497 10 37 5 622 Bath and lavatory wastes altered to discharge outside over gullies .. .. 135 2 .. .. 137 Rain water pipes disconnected from drains .. 16 184 .. .. .. 200 Water - closets cleansed and repaired 92 114 461 98 132 67 964 Water-closets, supply of water laid on to 404 307 200 60 112 146 1231 Urinals cleansed, repaired or water laid on 2 2 31 1 .. 2 38 Accumulation of manure, &c., removed 8 14 29 4 18 11 84 Cesspools abolished 1 1 12 9 5 2 30 Dust-bins provided 268 232 161 24 200 260 1345 Stables drained or paved and cleansed .. 1 32 4 3 1 41 Yards drained and paved 25 15 261 8 11 5 325 Unwholsome or dilapidated houses cleansed & repaired 89 123 19 .. 32 3 266 Leaky house-roofs and gutters repaired 131 85 203 29 13 133 594 Houses supplied with water 4 22 17 6 11 28 88 Water-cisterns covered and repaired 336 300 548 39 51 183 1457 Cistern overflow pipes disconnected from drains .. 10 143 .. 23 .. 176 Wells closed .. .. 10 .. .. .. 10 Pig nuisances removed 6 2 7 1 17 5 37 Unclassified nuisances 10 13 262 9 34 .. 328 Cases investigated by Magistrates 3 6 21 1 .. 3 34 Compulsory Orders obtained 3 5 15 1 .. 3 27 Compulsory works executed 3 5 15 1 .. 3 27 116 TABLE V. METEOROLOGICAL TABLE FOR LONDON, 1885. 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. AirDaily Range. Number of Nights it was Lowest_Reading at Night. Highest. Heading at flight. Mean. Diff. from Aveiage of 113 Years. Diff. from Average i 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. Diff. from Average of 43 Years. Mean (Satn—100). Diff. from Average of 43 Yean. Mean. Diff. from Average of 43 Years. Mean. Diff. fiom Average of 13 Years. 1 Amount. Diff. from Average of 70 Years. At or below 30 Between 30° & 40°. Above 40. 1884. 0 0 0 o o 0 0 0 0 in. in. grs. gr. in. in. grs. grs Sums. Sums. o O in. in. YEAR. 48.6 —0.1 —0.8 45.5 —0.8 42.6 —1.0 15.7 —O.l .281 — .014 3.2 —0.2 81 —2 29.754 — .019 542 0 24.00 -1.28 100 165 100 169 57.8 First Quarter 40.3 + 1.5 + 0.3 38.3 + 0.2 35.8 +0.3 11.7 -0.1 .211 + .002 2.5 +0.1 83 —0 29.719 —.047 551 —2 5.26 + 0.26 46 37 7 16.9 47.5 Second do 52.4 + 0.1 —0.5 48.4 —0.7 44.4 —1.1 19.8 -0.1 .296 —.012 3.3 0.2 75 —3 29.700 —.082 537 —1 5.82 0.01 18 47 26 22.9 54.3 Third do 59.1 —0.6 —1.1 55.0 —1.4 61.3 —1.7 20.7 + 1.0 .379 —.027 4.2 —0.3 76 —2 29.835 + .043 532 + 2 5.55 —1.80 3 31 58 22.3 57.8 Fourth do 42.3 —10 —1.7 411 —1.4 39.1 —1.6 10.6 —1.3 240 —.018 2.8 —0.3 87 —1 29.761 + .012 549 + 2 7.37 + 0.25 33 50 9 18.8 44.1 In this Table, + and — respectively signify that the number in the preceding column are above or below the average to the extent of the quantities to which these signs are prefixed.