WAN 37 THE Board of Works for the Wandsworth District. SANITARY DEPARTMENT, REPORT on the SANITARY CONDITION of the several parishes comprised in the Wandsworth District, DURING THE YEAR 1886. by the MEDICAL OFFICERS OF HEALTH. TO WHICH IS APPENDED TEE REPORT OF THE ANALYST. London: ASHFIELD, steam printer, bridge road west, battersea. 1887. To the Board of Works for the Wandsworth District. Gentlemen, We liave the honour to present our Report for the year 1886, on the vital statistics and sanitary condition of the Wandsworth District. The usual arrangement of matter has been adopted : the more general statistics which concern the whole District, being followed by local reports which will be of special interest to the members of the corresponding sub-districts. Where possible additional information has been incorporated in the reports, and every effort made to ensure their giving a complete and accurate representation of the health of the District. Many most encouraging features in the sanitary condition of the District will be apparent from a perusal of the following pages, and we have to congratulate you on a lower general Death-rate e than in any preceding year with the exception of 1885. The Table of Sanitary Operations on page 22 perhaps represents more faithfully than any other part of the Report, the share which the officers of the Sanitary Department acting under your supervision, may claim in producing this low death-rate, and we can assure you that no efforts will be lacking on our part to lessen the incidence of those diseases which can fairly be called Preventible. We have the honour to remain, Gentlemen, Your obedient Servants, The Associated Medical Officers of Health of the Wandsworth District, May 27th, 1886. INDEX. Page. Introductory Eeport on the Health of the Entire District 5 Dr. Kompster's Report for East Battersea 28 „ Oakman's „ West ,, 45 ,, Newsholme's ,, Clapham 56 ,, "Walker's „ Putney 70 „ Sutton's ,, Streatham 78 ,, Nicholas' ,, Wandsworth 91 ,, Muter's Analyst's Eeport 108 SPECIAL POINTS RAISED IN THE LOCAL REPORTS. Asylums Board Beturns 16 Causation of Summer Diarrhœa 34 Measles, fatality from 86,100 Estimated Population, fallacies of 80, 92 Eelationship of Birth-rate to Death-rate 29, 57 Infantile Death-rate 13, 61 Working-classes, relatively great Mortality of 62, 74 Water Supply, condition of Metropolitan 23 Dust-bins, disease and 40, 77 Dust-bins, suggested abolition of 40 Proposed Dust Cremator for Clapham 66 Sewer "Ventilation by up-shafts 41 Diseased. Meat, seizure of 42, 54 Analysis of Beer 108 Milk 109 REPORT, ON THE HEALTH AND SANITARY CONDITION OF THE ENTIRE DISTRICT. 1886. VITAL STATISTICS. Population. The official population of the Wandsworth District at the middle of the year 1886, was 257,742, being an increase of 9,332 on the previous year's population. This estimate is formed on the assumption that the rate of increase of the population was the same as during the decade 1871—81; and in the absence of a more frequent census enumeration, this seems to be the plan which is least open to objection. There is strong reason to think however, that especially in the case of the West Battersea, Wandsworth, and Streatham sub-districts, the true population is much higher than the estimated population. Births. The total births registered during the year numbered 8,896,—4,556 of males and 4,340 of females. The number of births and the birth-rates in the several sub-districts are compared in the following table:— 6 TABLE J. BIRTHS. RATES. Sub-Districts. Males. Females. Total. Birthrate. Rate of Natural Increase. Battersea East 1268 1255 2523 36.2 20.0 West 1356 1261 2677 39.0 22.9 Clapham 530 541 1071 25.5 12.5 Putney 177 175 352 23.0 11.2 Streatliam 568 510 1078 34.3 19.2 Wandsworth 657 598 1255 40.4 21.3 Whole District 4556 4 340 8896 34.5 17.4 The birth-rate calculated from the total births registered and the foregoing estimated population was 34.51 per 1,000 persons living, as compared with 34.6 in the previous year. The birth-rate for the whole of London during last year was 32.3 per 1,000, being the lowest on record since the year 1850. The natural increase of the population, or excess of births over deaths was 4,498 and the rate of natural increase 17.4 per 1,000. Deaths. The total deaths registered during the year numbered 4,398,—2,254 of males and 2,144 of females. The number of deaths and the deathrates of the several sub-districts are compared in the following- table:— TABLE II. DEATHS. Death-rate. Sub-Disteicts. Males. Females. Total. Battersea East 603 526 1129 16.2 West 682 666 1348 20.0 Clapham 255 290 545 12.9 Putney 89 92 181 11.2 Streatham 246 227 473 15.0 Wandsworth 379 343 722 19.0 Whole District 2254 2144 4398 17.06 7 In Table II. the 1,348 uuaths in West Battersea include 261 deaths in the Union Infirmary and 11 in the Bolingbroke Pay Hospital, without which the death-rate would be 15*0 per 1,000. The 722 deaths in Wandsworth include 144 in public institutions within the subdistrict, without which the death-rate would be 17.8 per 1,000. The death-rate was 17.06 per 1,000 persons; the lowest for ten years except last year, in which it was 16.87 per 1,000. The death-rate for the whole of London during last year was 19'9 per 1,000. The birth-rates, death-rates, and rates of natural increase of the past and ten previous years are shewn in the following table:— TABLE III. Birth-rates, Death-rates, and rates of Natural Increase in the entire district during the ten years 1876—85, compared with those of the year 1886. Years. Births. Birth-rate per1000. Deaths. Death-rate per 1000. Natural Increase. Rate of Natural Increase per 1000. 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 1885 8606 34.60 4192 16.87 4414 17.90 Mean of Ten Year. 1876—85 ) 7367 36.94 3647 18.35 3709 18.61 1886. 8896 34.60 4398 17.06 4489 17.4 - 8 It will be seen from this table that the death-rate is 1.29 per 1,000 less than the decennial average. It is also 3.84 per 1,000 less than the rate for the 28 great towns of England and Wales, and 2.84 per 1,000 less than that for the whole of the Metropolis. A glance at the following table shews the striking diminution in the mortality of this District since the year 1851, notwithstanding the tendency to raise the mortality which an increasing density of population always exerts. Death-rates in District per 1,000 oe the Population. During 10 years, 1851—60 20.40 „ „ 1861—70 19.34 „ „ 1871—80 18.06 During the year 1881 17.16 1882 17.42 1883 17.49 „ „ 1884 17.85 ,, ,, 1885 16.87 „ „ 1886 17.06 Deaths in The deaths already enumerated do not institutions, include those of inhabitants of this District, who have died in various hospitals and other institutions outside the District. To some extent the absence of these deaths from our tables of mortality is doubtless counterbalanced by the death in the Wandsworth District of temporary immigrants from the country, and by the mortality in the public institutions of West Battersea and Wandsworth. In the following table the deaths occurring in Outlying Institutions have been arranged according to the character of the Institution in which they occurred and the sub-district to which they properly belong. 9 TABLE IV. Deaths in Outlying Institutions. CAUSES OF DEATH. Number in Entire District. East Battersea. West Battersea. Clapham. Putney. Streatham. Wandsworth. Union Infirmary. General and Special Hospitals. Asylums Board Hospitals. Small Pox .. .. .. .. .. .. .. .. .. .. Scarlet Fever 2 l .. l .. .. .. .. .. 2 Diphtheria 4 .. 3 l .. .. .. .. 4 . . Enteric Fever 9 7 2 .. .. .. .. 3 6 Whooping Cough 3 2 .. l .. .. .. 2 1 .. Measles .. .. .. .. .. .. .. .. .. .. Other Zymotic Diseases 13 11 .. .. .. 2 .. 2 11 .. Tubercular Diseases 69 34 9 10 1 3 12 3-5 32 2 Cancer 23 8 3 4 2 3 3 8 15 .. Rheumatism 3 1 .. 1 .. .. 1 1 2 .. Respiratory Diseases 71 23 14 10 3 11 10 36 35 .. Circulatory Diseases . 63 18 10 14 4 8 9 30 32 1 Nervous Diseases 64 28 7 8 3 5 13 2b 36 2 Other Diseases 111 32 10 23 5 15 26 55 54 2 Violence 27 13 5 3 1 1 4 2 25 .. Total 462 178 63 76 19 48 78 197 250 15 Corresponding Totals in preceding year 469 179 68 77 29 38 78 180 241 48 It will be seen that 462 deaths occurred in outlying institutions, of which 197 were in the Union Infirmary, 250 in the general and special hospitals of the metropolis, and 15 in the Asylums' Board Hospitals. In this table the deaths of West Battersea inhabitants occurring in Union Infirmary (61 in number), are not included. As the total deaths occurring in the Union Infirmary (261 in number) have teen already included in the 4,398 deaths occurring within the district, there only remain 10 deaths to add, to obtain the complete mortality of this district. This gives a death-rate of 18.09 per 1,000, as compared with 18.00 in the previous year. Use of outlying Institutionsby each Sub-district. The number of deaths in outlying institu- . each tions enables one to iorm an approximate Sub-district, 0f the relative use of such institutions by each sub-district; and an interresting side-light on their relative social condition is thus obtained. For every 1,000 of the population there died in outlying institutions including the Union Infirmary :— For East Battersea .. 2-55 per 1,000 ,, West Battersea .. 1'88 „ ,, Clapham .. 181 ,, ,, Putney .. 1*90 ,, ,, Streatham .. 1-59 ,, ,, Wandsworth .. 2'41 ,, Stated as per centages of the total number of deaths, in East Battersea, 13 6 per cent of the total deaths occurred in outlying institutions; in West Battersea, 10'5 percent; in Clapham, 12*G per cent; in Putney, 13*8 per cent; in Streatham, 9'2 per cent ; and in Wandsworth, 9'7 per cent. Table V. gives some very important vital statistics of the Wandsworth District. The death-rates of the several sub-districts, inclusive and exclusive of outlying institutions are given, as well as the amount and density of population and the proportional number of the industrial classes which each sub-district possesses. In table VI. the deaths occurring in the entire District during 188G, are classified according to Sex, Age, and Social Position, the relative numbers occurring in each sub-district being also given. 11 TABLE V. SUB-DISTRICTS. Population in the middle of 1886. Percentage of Total, Population. Density of Population— Number of Persons to an Acre. Relative Mortality per cent. of Industrial and other Classes. Death-rate per 1000 excluding deaths in Public Institutions, within and without the Subdistrict. Death-rate per 1,000 including deaths in Outlying Institutions, excluding deaths in Public Institutions within the Subdistrict. Industrial Classes. Other Classes. East Battersea 69,602 27.00 73 4 83.4 16.6 16.2 187 West Battersea 67,265 26.09 48.0 82.9 17.1 15.9 18.0* Clapham 41,945 16.27 34.0 57.1 42.9 12.9 14.7 Putney 15,210 5.90 6.9 60.0 40.0 11.2 13.1 Streatham 31.400 12.18 9.0 42.7 57.3 15.0 165 Wandsworth 32,320 12.56 13.0 64.2 35.8 17.8 21.4 *In estimating this rate, the deaths in Union Infirmary which belonged to West Battersea (64 in number) are included, in order that the rate may be compared with that of the other sub-districts. 12 TABLE VI. Summary of Deaths and their Causes, registered in the entire District during 1886, classified according to Sex, Age, and Social Position, and shewing also the relative numbers in each Sub-district. POPULATION of entire District, (Census) 1881, 210,434. Official Population in middle of 1886, 257,742. Area in Statute Acres, 11,695. Total Deaths from each class of Disease in the entire District. Sub-Districts. Sex. Age. Social Position Kast Battersea—Population, 69,602. Area in acres, 947, West Battersea—Population, 67,265. Area in acres, 1,396 Clapham—Population. 41,945. Area in acres, 1,233. Putney—Population, 15,210. Area in acres. 2,176. Streatham. Tootintr and tion $1 31,400 Ares in acres 3465. Wandswoith—Population, 32,320. Area in 2478. Males. Females. Uuder 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 Laboring Class. CAUSES OP DEATH. 1. Zymotic. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 124 41 26 11 4 11 28 70 54 31 86 6 ... 1 ... ... ... ... 5 18 101 Scarlet Fever 21 9 5 l ... ... 6 9 12 3 14 1 1 2 ... ... ... ... 1 ... 20 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Eever 39 11 13 3 1 3 8 18 21 1 2 6 7 14 8 1 ... ... ... 12 27 Puerperal Eever 18 8 1 2 2 ... ... ... 13 ... ... ... ... 12 1 ... ... 1 ... 3 9 Diphtheria 32 6 3 6 1 6 10 22 10 6 12 9 3 1 ... 1 ... ... 5 7 20 Whooping Cough 213 62 42 34 18 26 31 90 123 96 113 4 ... ... ... ... ... ... 10 30 173 Erysipelas 24 10 6 2 1 1 4 13 11 4 1 1 2 2 8 6 ... 2 1 5 16 Diarrhœa, Dysentery, & Cholera Other Zymotic 230 78 70 25 9 20 28 122 108 187 31 1 ... 4 2 3 2 1 15 41 173 Diseases 5 4 ... ... ... ... 1 2 3 5 ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 701 232 166 84 36 67 116 346 355 333 259 28 13 36 19 11 2 4 37 116 544 11. Constitutional. Gout, and Rheumatism 28 16 13 3 ... ... 6 16 12 ... 1 1 3 8 4 10 1 ... 2 5 21 Cancer and other Tumours 117 21 33 23 2 17 21 42 75 ... 1 2 1 17 51 54 1 11 11 29 66 Other Constitutional Diseases 26 11 5 6 ... 1 3 13 13 13 3 1 2 1 5 1 ... ... 2 3 21 Tubercular Phthisis 332 87 114 42 9 26 54 179 153 13 16 8 36 139 101 18 1 5 28 62 237 Tabes Mesa 237 93 92 21 3 4 24 129 108 167 49 1 7 7 6 ... ... 2 8 28 199 Hydrocephalus 82 22 23 14 7 8 8 46 36 35 34 10 2 1 ... ... ... ... 1 13 68 Scrofula. 11 ... 8 ... ... 2 1 7 4 8 ... 1 1 1 ... ... ... ... 4 7 Nervous 627 120 169 79 29 79 151 326 301 181 81 8 14 52 113 154 24 25 46 45 411 III. Local. Circulatory 298 55 101 35 18 40 46 139 159 8 5 6 10 27 103 126 13 11 29 71 187 espiratory 952 268 315 03 35 96 185 496 456 251 212 21 13 55 23 231 46 30 53 155 714 Digestive 215 27 69 39 10 41) 30 106 109 52 7 9 7 17 69 50 4 14 28 55 118 Urinary 97 10 21 16 8 16 26 57 40 1 ... 3 2 14 11 31 5 8 10 34 15 Generative 31 3 11 5 4 4 4 2 31 ... ... ... ... 23 4 3 ... ... 4 5 22 Locomotory 23 2 18 1 ... 2 ... 15 8 4 3 1 4 3 4 4 ... ... 2 2l Integumentary 6 ... 6 ... ... ... ... 1 5 ... 1 1 ... ... 1 3 ... ... 1 ... 5 IV. Developmental. Premature Birth, Low Vitality and Congenital Defects 299 114 61 28 8 43 45 177 122 295 2 2 ... ... ... ... ... ... 14 42 243 Old Age 192 25 74 33 7 21 32 69 123 ... 5 7 9 12 25 20 19 70 11 90 ... 13 ... 21 2 48 10 110 88 V. Violence 100 28 35 12 2 6 17 77 23 24 vI. lldefined & Illdefined 17 2 11 ... 1 1 2 9 8 7 ... 3 ... 4 3 ... ... ... ... 4 13 oot specified not sp'fd. 5 3 ... l ... ... 1 ... 5 1 ... ... ... ... 2 1 1 ... ... 2 3 Totals 4398 1129 1348 545 179 473 722 2252 146 1396 679 113 123 442 677 788 188 123 297 833 3143 13 TABLE VII Social Status. 1879 1880 1881 1882 1883 1884 1885 1886 Nobility & Gentry 330 3.40 2.71 3.43 2.48 4.41 2.76 2.79 Professional Class 5.90 5.50 5.12 4.44 5.66 6.25 4.67 6.75 Middle Class 17.40 16.90 19.00 20.85 19.59 25.66 19.10 18.94 Industrial Class 73.40 74.20 73.17 71.28 72.27 63.68 73.47 71.52 100.0 100.0 100.00 100.00 100.00 100.00 100.00 100.00 Deaths at different ages. The deaths of children under 5 years of age amounted to 47.2 per cent of the total deaths, as compared with 46.4 per cent in the previous year. At the other extreme of life, i.e. at 60 years of age and upwards, 21.9 per cent of the total deaths occurred as compared with 21.2 per cent in the previous year. Infantile Mortality. The deaths of children under one year of age amounted to 31.7 per cent of the total number of deaths. It is evident however, that this does not represent the true infantile mortality, as the per centage proportion of infantile deaths to total deaths will obviously vary with the number of children born. Hence it is necessary to express the mortality under one year in terms of the number living at that age, as obtained from the birth-returns. The following expresses the result as stated in this way:— Deaths under 1 year per 1,000 births— In East Battersea 169 In Wandsworth 164 ,, West ,, 153 England & Wales 150 ,, Clapham 142 ,, 20 great towns 169 ,, Putney 150 „ Leicester 211 ,, Streatham 133 „ Preston 233 Social Position of Deceased. In the following table the relative proportion per cent of the mortality borne by the several classes of inhabitants of the District during the years 1879—85 is compared with that of last year. 14 Causes of Mortality. The relative number of deaths from the Various diseases, zymotic diseases being given in greater detail, are stated in Table VI. In the following table, these are compared with the corresponding deaths of the ten previous years. TABLE VIII. Showing the total number of deaths and their causes registered in the entire District, during the eleven years 1876-86, with the relative numbers of each class of disease. DISEASES, And other causes of Death 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 Class: Small Pox 26 57 19 4 3 37 1 .. 9 5 .. Measles 88 64 84 125 59 134 115 133 182 140 124 Scarlatina 86 58 39 134 173 100 119 65 47 11 21 Diphtheria 15 7 19 17 19 18 51 63 43 29 b2 Whooping Cough 126 73 149 148 123 105 163 133 145 178 213 Typhus and other fevers 47 64 39 62 44 37 49 52 58 41 39 1 Zymotic Diarrhœa & Choleraic Disease 159 114 182 94 213 149 117 158 239 193 230 Erysipelas 13 13 5 13 10 15 18 10 28 17 24 Metria, Childbirth 26 20 7 28 23 29 19 25 24 23 13 Carbuncle .. .. .. .. .. .. 3 .. .. .. .. Influenza .. 1 .. .. .. .. .. .. .. .. .. Quins ,. 1 .. 1 1 .. Croup Other Zymotic Diseases 27 20 39 40 19 18 3! 60 38 1 5 Totals of Zymotic Class 613 491 583 665 687 642 687 699 817 638 701 2. Gout and Rheumatism 14 13 15 8 15 25 25 25 24 32 28 3. Cancer & other Tumors 97 101 106 91 110 118 144 114 148 105 117 4. Other Constitutional Diseases .. .. .. .. .. .. .. .. .. 23 26 5. Tubercular Diseases 555 514 501 513 625 557 521 654 715 664 662 6. Nervous 316 450 503 474 464 510 539 574 602 594 627 7. Circulatory 170 204 212 203 193 245 251 255 269 278 298 8. Respiratory 561 519 694 891 657 695 850 829 758 982 952 9. Digestive 126 155 150 117 155 208 195 234 227 186 215 10. Urinary 62 63 42 74 66 70 89 99 80 81 97 11. Generative 23 29 19 25 20 35 32 30 35 42 33 12. Locomotory .. .. .. .. .. .. .. .. .. 11 23 13. Integumentary 5 6 1 3 8 3 9 10 3 9 6 14. Premature Birth, Low Vitality, Malformation, &c. 226 212 177 170 266 232 234 241 304 259 299 15. Old Age 150 126 141 141 136 120 153 185 154 171 192 16. Violence 90 82 75 83 96 113 104 94 111 97 100 17. Ill Defined and Not Specified) 46 26 56 68 95 44 18 40 19 21 22 Totals 3154 2991 3275 3526 3593 3647 3851 4083 4266 4193 4398 15 Zymotic diseases caused 15.9 per cent of the total deaths as compared with 15.2 per cent in the previous year. The zymotic death-rate was 2.71 per 1,000 of the population, as compared with 2.56 in the previous year. The largest number of deaths from zymotic diseases were caused by the seven chief epidemic diseases enumerated in the following table:— TABLE IX. Whole District. East Battersea. West Battersea. Clapham. Putney. Streatham. Wandsworth. Small-pox .. .. .. .. .. .. .. Measles 124 44 26 11 4 11 28 Scarlet Fever 21 9 5 1 .. .. 6 Diphtheria 32 6 3 6 1 6 10 Enteric Fever 39 11 13 3 1 3 8 Whooping-cough 213 62 42 34 18 26 31 Epidemic Diarrhoea 230 78 70 25 9 20 28 Other Zymotic Diseases 42 22 7 4 3 1 5 Total Deaths from Zymotic Diseases 701 232 166 84 36 67 116 Zymotic Deathrate 2.71 3.33 2.4 2.00 2.36 2.13 3.58 Dea'.h-rate from all Diseases 17.06 16.2 15.9 12.9 11.2 150 19.0 If to the 701 deaths from zymotic diseases be added the 31 deaths from the same diseases in outlying institutions of inhabitants of this district (see table IV.), the zymotic death-rate becomes 2.84 per 1,000 of population. By comparing tables IV. and IX. the relative local incidence of the various epidemic diseases will be best 16 understood. It will be seen that no death from Small Pox occurred; that Scarlet Fever caused 21 deaths at patients' own homes and 2 at the Asylums Board Hospitals; Enteric Fever, 39 deaths within the District and 9 without; Diphtheria, 32 within and 4 without. Diarrhœa was the most fatal of the epidemic diseases, causing 230 deaths; Whooping Cough coming next with 213, and Measles next with 124 deaths. TABLE X. Number of cases of Infectious Diseases admitted into the Metropolitan Asylums Board Hospitals during 1886. Smalll Pox. Scarlet Fever. En'eric Fever. Typhus Fever Uncertain. Measles. Battersea 4 35 19 .. l .. Clapham . . 22 2 .. .. .. Putney . . 1 .. .. .. .. Streatham . . 14 .. .. .. .. Wandsworth .. 4 4 .. .. .. Wandsworth & ham Infirmary . . • • 9 .. l . . Entire Wandsworth District 4 76 34 . . 2 • • Rest of Metropolis . . 129 1662 314 5 29 3 Asylums' Board Hospitals. The preceding figures only give the mortality from the various epidemic diseases. In the absence of notification of all cases of the chief epidemic diseases, which cannot be obtained without compulsory powers, the following table of patients admitted into the Asylums Board Hospitals during the past year, gives the only further available indication of the number of cases of infectious disease in this district and in the metropolis generally. 17 The most striking feature in this table is the great diminution in the number of Small-Pox cases in the whole of London (133 cases, as compared with 5060 in the previous year); and we may add, the almost complete absence of this disease during the latter half of the year. The Scarlet Fever admissions were over 500 more than in the previous year. This is probably partly due to a larger use of the isolation available in the Asylums Board Hospitals, but also to a somewhat increased prevalence of and mortality from the disease. Thus in the Wandsworth District, 21 deaths from Scarlet Fever occurred, as compared with 11 in the previous year. The admission of 3 cases of Measles was doubtless owing to mistaken diagnosis, as the Asylums Board do not provide accommodation for cases of Measles, although this is one of the most infectious and (indirectly at least), fatal of zymotic diseases. Nor do the Asylums Board admit cases of Diphtheria to their hospitals, owing to a technical legal difficulty in including this disease under the term 'Fever.; TABLE XI. SUBDISTRICr.S. N umber of Births .Returned from 1st January to 131st December, 188.). Successfully Vaccinated. Insusceptiblo of Vaccmation. Had Small-pox. Bead Unvaccinated. Postponed by Medical Certificate. Removed to Districts Vaccination Officer of which has been duly apprised. Removed to paces unknown, or which cannot bo reached; and cases not having- been found. East Batter sea 2497 2015 17 .. 234 35 3 193 West Battersea 2583 2070 4 .. 247 40 2 220 Clapham 1029 843 1 .. 91 27 15 40 Putuey 329 269 2 .. 27 10 4 12 Streatham 1085 876 2 .. 34 20 2 59 Wandsworth 1121 951 1 .. 91 15 4 59 Totals 8614 7024 27 .. 724 207 30 583 18 During the year 1885, as shewn in Table XI., out of 8,644 children, 7,024 were successfully vaccinated, and the remainder were accounted for by death, insusceptibility to vaccination, or postponement on account of illness, except 583, i.e., 6.7 per cent. In the previous year 6.6 per cent, were accounted for. Although the Small-pox epidemic of 1885 has in the latter part of 1886 almost entirely died out, we cannot look for a continued immunity from the disease; and the presence of so large a proportion of persons unprotected by vaccination (as well as of a further proportion of persons who have been but imperfectly vaccinated), renders it probable that in a year or two there will be such an aggregation of unprotected persons as to make another outbreak of Small-Pox inevitable. Inquests. Deaths . by Violence. The inquests held last year were 221, as compared with 174 in the previous year, and formed 50 per cent. of the total number of deaths. The whole of the deaths which formed the subject of Coroner's inquiry in the several sub-districts are classified according to their verdicts in Table V. It will be seen that of the total number, 114 were due to natural causes, and 107 to violence. Of the latter, 80 were accidental, 16 were suicidal, 3 were homicidal, and in 8, open verdicts were returned. 19 TABLE XII. Verdicts. Sub-Districts. Total. Battersea Clapham , Putney | Streatham Wandsworth East West Deaths from Natural Causes: 114 29 32 15 2 10 26 Deaths from Violence: .. .. .. .. .. .. .. Accidental: Drowning 21 9 7 .. 2 .. 3 Suffocation 23 7 4 .. . . .. 3 Railway Injuries 6 3 2 1 .. .. .. Scalds and iiurns 7 .. 3 1 .. .. 2 Poisoning 2 .. 2 .. . . .. .. Concussion, Fracture, &c. 7 4 1 .. .. .. 2 Iujuries from Fall 8 .. 3 .. .. .. 2 Hydrophobia 5 .. .. 1 .. 1 Other Injuries 1 2 1 .. 1 .. .. Suicidal: Poisoning 3 2 .. .. .. .. Hanging 2 1 1 .. .. .. Shooting 3 l .. .. .. 2 Drowning 5 1 3 1 .. .. .. Cut-Throat 3 2 1 . .. .. Homicidal: Neglect at Birth 1 .. .. .. .. Manslaughter 1 .. .. .. 1 Poisoning 1 1 .. .. .. .. .. Open Verdicts: Found Drowned 1 .. .. .. .. .. 1 Found Dead 6 1 2 .. 1 .. 1 Newly Born 1 1 2 .. .. .. .. Totals 221 60 64 29 7 17 44 20 Uncertified Deaths. The number of deaths in which the cause was not certified by medical testimony, but in which the Coroner did not think an inquest necessary was 70, as compared with 58 in the previous year. Of the 70, 18 occurred in East Battersea, 28 in West Battersea, 4 in Clapham, 2 in Putney, 11 in Streatham, and7 in Wandsworth. Sicknes and Mortality among Par¬ochial Poor. The nature, amount and fatality of the sickness that occurred among; the parochial poor in the several sub-districts are set forth in Table XIII., which forms a valuable index of the sickness occurring in the district generally. The total number of cases coming under treatment was 3,364, as compared with 3,218 in the previous year. The proportion of deaths to cases treated was 3.1 per cent, as compared with 3.7 per cent. in the previous year. Sanitary Operations of the Year. A study of Table XIV. will shew the tailed sanitary work carried out in each subdistrict during the past year, and the results obtained. This table embodies the measures which are being steadily and persistently taken by your Sanitary Officers to prevent the spread of disease, and remove the local unsanitary conditions to which disease is so frequently due. 21 TABLE XIII. 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, 1886. 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—Diarrhœa 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 i Cases Deaths Cases Deaths 1 Cases Deaths Cases Deaths Cases Deaths Cases Deaths | CaRes Deaths | Cases Deaths Battersea East 1098 33 3 .. 7 2 20 1 2 .. 2 28 1 .. .. 16 .. 1 .. .. .. 159 6 36 7 5 2 10 .. 800 12 West 686 27 2 .. 6 .. 7 .. .. .. 2 .. 10 .. .. .. 5 .. 1 .. 2 .. 175 5 5 6 18 3 10 .. 443 14 Clapham 540 24 .. .. 7 1 5 .. 1 1 12 2 37 3 .. .. 5 .. 3 .. 15 .. 175 4 18 2 3 1 21 .. 338 10 Putney and Roohamptor 126 3 .. .. 5 .. .. .. .. .. 4 .. 5 1 .. .. .. .. .. .. .. .. 22 .. 7 .. .. .. 5 .. 75 1 Streatham, including Tooting and Balham .. 213 4 .. .. 16 .. 12 .. .. .. 2 .. 18 .. .. .. 1 .. 1 .. .. .. 68 .. 8 1 .. .. 6 .. 78 4 Wandsworth 696 25 .. .. 44 2 5 .. .. .. 23 3 44 1 .. .. 6 .. 7 .. .. .. 183 5 5 2 4 1 39 .. 325 11 Totals 3364 116 5 85 6 5 1 3 1 54 7 142 6 .. .. 33 .. 13 .. 17 .. 782 20 50 17 30 7 91 .. 2056 52 *The ratio of deaths to cases treated is 3.1 per cent. 22 TABLE XIV. Summary of Sanitary Operations in the entire District during the year 1886. East Battersea. West Battersea. Clapham. Putney. Streatham and Tooting. Wandsworth. Total. Number of Houses & Premises inspected 7711 8178 3919 2277 3608 4196 29988 1st Notices served 848 830 1061 268 329 526 3861 2nd Notices served 119 145 276 6 9 93 648 Number of houses disinfected after infectious diseases 73 54 34 4 23 192 380 Number of houses in which infectious disease recurred after disinfection .. .. .. .. .. .. .. Number of houses from which bedding, &c., was burnt 2 1 16 2 4 1 26 Disinfecting apparatus at Putney, number of times used .. .. .. 8 .. .. 8 Overcrowding abated 19 6 10 2 2 1 49 Rooms cleansed and repaired. 58 61 220 8 65 17 429 Staircases & passages cleansed and repaired 23 3 24 .. 23 5 78 New drains and drains relaid 377 95 56 377 79 984 Number of feet of new sewers and branch drains 18301 8474 5216 5084 2010 39086 Drains cleansed and repaired 384 564 175 23 190 88 1424 Syphon traps fixed to drains 188 68 1002 .. 320 .. 1578 Sinks altered to discharge outside over gullies 59 26 319 5 56 .. 465 Bath and lavatory wastes altered to discharge outside over gullies .. 1 287 .. 34 .. 31 Rain water pipes disconnected from drains .. .. 373 .. 39 .. 412 Water-closets cleansed and repaired 43 38 366 95 171 97 810 Water-closets, supply of water laid on to 383 409 39 58 123 278 1290 Urinals cleansed, repaired or water laid on 6 7 1 .. 31 .. 45 Accumulation of manure, &c., removed 10 15 30 8 52 5 120 Cesspools abolished 1 3 4 .. 17 1 26 Dust-bins provided 187 155 65 18 113 131 669 Stables drained or paved and cleansed 8 .. 12 .. 5 .. 25 Yards drained and paved 32 15 70 8 14 7 146 Unwholesome or dilapidatec houses cleansed & repaired 84 58 .. •• 23 11 176 Leaky house-roofs and gutters repaired 66 70 119 8 14 46 323 Houses supplied with water 27 18 17 2 7 18 89 Water-cisterns covered and repaired 471 245 457 29 48 239 1489 Cistern overflow pipes disconnected from drains .. .. 118 .. 32 .. 150 Wells closed .. .. 1 .. .. .. 1 Pig nuisances removed 2 2 .. .. 15 1 20 Unclassified nuisances . 7 10 381 7 52 11 468 Cases investigated by Magistrates 6 7 3 .. .. .. 16 Compulsory Orders obtained • • • • 3 • • .. • • 3 Compulsory works executed •• •• 3 .. .. .. 3 23 Water Supply. The Thames water with which this District is supplied for drinking purposes, was somewhat freer from organic matter than the average. Attention may he called however, to Dr. Frankland's weighty remarks in his annual report to the Registrar-General on the Metropolitan Water Supply. "A small proportion of the solid matter, however, is always organic in nature, and this, although quite insignificant as regards its absolute amount, is yet of the greatest importance when its possible origin is taken into consideration. It must be borne in mind that the rivers Thames and Lea necessarily receive above the intakes of the Metropolitan Companies a certain amount of animal matter derived partly from sewers, cesspools, and sewage works, and partly from manured land. Such animal substances may at any time be accompanied by matters capable of producing zymotic disease, and although the treatment which the water subsequently receives at the hands of the Water Companies is calculated greatly to diminish the risk of such morbific matter reaching the consumer, its entire removal is not guaranteed. It is therefore satisfactory to know that most of the companies drawing their supplies from these rivers are making serious efforts to diminish the volume of water taken directly from the streams. It is desirable, however, that this action of the water companies should be supplemented by the enforcement of the laws prohibiting the discharge of sewage into the Thames and Lea." A large part of the District still receives but an intermittent supply of water, and there can be no doubt that this is the cause of serious danger to health and actual disease. We hope that when our next annual report is issued, it will be possible to chronicle a considerable extension of the constant system of supply. Meteorology of the Year. The general characters of the climate during 1886, may be gathered from Table XV. The mean temperature of the third quarter was 0°7 Fahr. above the average of 45 years, and the rainfall for the same period 2*43 inches below the average of 72 years. In accordance with these facts, one finds that the annual mortality from Diarrhoea in this District was 230, as compared with 193 in the previous year. 24 TABLE XV. METEOROLOGICAL TABLE FOR LONDON, 1886. 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., FR.S. Winter Jan., Feb March.. Spring April, May, June. Summer July, Aug., Sept. Autumn Oct., Nov., Dec. Temperature of Elastic Force of Vapour. Weight of Vapour in a Cubic Foot of Air. Degree of Humidity. Reading of Barometer. "Weight of a Cubic Foot of Air. Rain. Reading of Thermometer on Grass* Air. Evaporation. Dew Point. Air— Daily Range. Number of Nghts it wag Lowest Reading at Night. Highest Reading at Night. Mean. Diff. from Average of 115 Years. Diff. from Average of 45 Years. Mean. Diff. from Aveage of 45 Years. Mean. Diff. from Average of 45 Years. Mean. Diff. from Average of 45 Years. Mean. Diff. from Average of 45 Years. Mean. Diff. from Average of 45 Years. Mean (Satn=100). Diff. from Average of 45 Years. Mean. Diff. from Average of 43 Years. Mean. Diff. fiom Average of 45 Years. Amount. Diff. from Average of 72 Years. At or below 30 Between 30° & 40°. Above 40°. 1886. ° ° ° ° ° ° ° ° ° in. in. grs. gr. in. n. grs. grs. Sums, in. in. Sums. o ° YEAR. 48.7 +0.1 —0.7 45.9 -0.6 43.0 —0.6 15.6 +0.0 .291 —.004 3.3 —0.1 81 —1 29.734 —.024 542 0 24.21 -1.85 90 141 134 15.0 58.2 First Quarter 36.5 —2.3 —3.5 34.8 —3.3 32.3 —3.2 10.6 —1.2 .183 —.026 2.2 —0.2 85 + 1 29.737 + .027 566 +3 5.38 + 0.14 52 30 8 l6.5 47.1 Second do. 52.5 +0.2 —0.4 48.8 -0.2 45.2 +0.2 19.7 —0.3 .303 —.002 3.4 —0.1 77 —1 29.769 -.012 538 0 5.93 +0.14 8 50 33 18.8 50.2 Third do. 61.2 + 1.5 +0.7 57.1 + 0.8 53.6 + 0.5 20.6 +0.9 .412 + .000 4.6 —0.0 77 —1 29.800 + .014 529 -1 4.87 —2.43 0 19 73 31.0 58.2 Fourth do. 44.6 +0.9 +0.5 43.0 +0.4 41.0 +0.5 11.7 +0.7 .265 + .007 3.0 -0.1 87 —1 29.624 -.125 541 —3 8.03 + 0.30 30 42 20 150 48.1 III 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. LOCAL SUMMARIES. 27 BATTERSEA. The estimated population of the whole parish on the middle day of the year 1886 was 136,867. The natural increase, being the excess of births over deaths was 2,703, and amounts to nearly one half of the estimated increase of population, shewing that the large and rapid addition to the number of inhabitants which has occurred in Battersea during the last twenty years, still continues. The births during the year were registered as males, 2,624; females, 2,516, and the total number was 5,240, being equal to an annual birth-rate of 38.3 per thousand, that for London being 323 per thousand. The deaths were—of males, 1,285; of females, 1,192, the total being 2,477, equal to a death rate of 181 per thousand. If 129 non-parishioners who died in the Union Infirmary be excluded, the total deaths would be 2,348, and the death rate 17.1 per thousand. The death rate for the Metropolis was l9.9 per thousand for the year under consideration. 28 EAST BATTERSEA. An estimate of the population of this sub-district by the official method employed by the Registrar-General, gives 69,602 as the number of inhabitants calculated to the middle day of the year 1886. This is an increase of 2,948—one-tenth of the ascertained addition to its numbers during the ten years, 1871-81. That this assumed increase is not an excessive one may be deduced from the fact that the natural increase of population, being the excess of births over deaths during 1886 was 1,394, leaving the probable increase by immigration as 1,554. The above-stated natural increase of population was equal to a rate of 20 per thousand, being rather less than in 1885, when it was 21.2. The subjoined table illustrates the relations of the birth and death rates with the actual natural increase of population during the last decade. 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. 2 1,067 1878 2,185 42.0 895 17. 8 1,290 1879 2,344 42.0 978 17.5 1,366 1880 2,257 41.5 1,030 18.9 1,127 1881 2,349 41.1 966 16.8 1,383 1882 2,352 39.1 992 16.4 1,360 1883 2,383 39.2 1,003 16.5 1,380 1884 2,621 41.1 1,184 18.5 1,437 1885 2,496 41.1 1,071 16.0 1,425 1886 2,523 36.2 1,129 16.2 1,394 29 The most prominent feature in this table is the remarkable decrease in the birth rate which, as in all other densely-populated localities, shews a steady diminution year by year. This is doubtless readily explained by the fact that the enormously increased population of the sub-district during the last twenty years was caused by the immigration of large numbers of young persons of the child-producing age—and as the mean age of the residents of the sub-district becomes greater, a smaller number of births occur in relation to the population. This lowering of the birth rate also tends to lower the death rate, as the greatest mortality is found among very young children—for instance, the death rate under one year in the present report will be found to be 37.8 per cent. of the total mortality, that under five years 21.7 per cent., together amounting to 59.5 per cent. of the total deaths, while the mortality at 20 years and upwards, including as it does the inevitable mortality of old age, amounts to but 32.7 per cent. of deaths at all ages. Births. The births registered during the 52 weeks included in the year 1886, numbered 2,523, of which number the males were 1,268, and the females 1,255. The consequent birth-rate was 36.2, which reference to the preceding table will shew is lower than that of any year since 1879, slowly approximating to the birth rate for London, 32.3, which in itself is the lowest since 1850. Mortality. The deaths of 603 males and 526 females were registered during 1886, the total number being 1,129, and the death rate 16.2 per thousand, exceeding that of the preceding year by 0.2 per thousand, that however, having been the lowest yet recorded. The Metropolitan death rate for the year was 19.9. 30 TABLE 11. Statistics of Mortality. EAST BATTERSEA. Population (Census) 1881 54,675 Official Population in middle of 1886, 69,602 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 year*. From 5 to 11 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. 1 Industrial and Laboring Classes. CAUSES OF DEATH. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. I. Zymotic. Measles 44 23 21 13 28 2 .. 1 .. .. .. .. .. 4 40 Scarlet Fever 9 3 6 3 3 1 1 1 .. .. .. .. .. .. 9 Simple Continued Fever 1 .. 1 .. .. 1 .. .. .. .. .. .. .. .. 1 Enteric Fever 10 6 4 1 .. 3 2 1 3 .. .. .. .. 2 8 Puerperal Fever 8 .. 8 .. .. .. .. 8 .. .. .. .. .. 2 6 Diphtheria 6 3 3 1 3 1 1 .. .. .. .. .. .. 2 4 Whooping Cough 62 27 35 25 37 .. .. .. .. .. .. .. 2 3 5i Erysipelas 10 5 6 1 1 1 1 2 3 1 .. .. .. 1 9 Diarrhœa & Dysentery. 78 41 37 60 16 1 .. .. 1 .. 3 9 6b Infantile Cholera 4 2 2 4 .. .. .. .. .. .. .. .. .. .. 4 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 232 110 122 104 92 10 5 13 7 1 .. .. 5 23 204 II. Constitutional. Gout and Rheumatism 6 2 4 .. 1 .. 2 2 1 .. .. .. 2 1 3 Cancer & other Tumours 21 7 14 .. .. .. 1 10 10 .. .. 1 1 3 16 Other Constitutional Diseases 11 5 6 9 1 1 .. .. .. .. .. .. .. 1 10 Tubercular Phthisis 87 54 33 .. 5 5 11 39 23 4 .. .. 7 9 71 Tabes Mesa 93 56 37 63 23 1 3 1 2 .. .. .. 2 8 83 Hydrocephalus 22 10 12 6 12 3 1 .. .. .. .. .. .. 4 18 Scrofula .. .. .. .. .. .. .. .. .. .. .. .. .. •• in. Local. Nervous 120 60 60 31 30 2 6 3 23 22 3 .. 4 20 96 Circulatory 55 30 25 .. 2 1 1 7 22 20 2 .. 4 l5 36 Respiratory 268 149 119 90 73 8 3 15 37 38 4 3 4 29 232 Digestive 27 13 14 3 2 2 1 2 11 6 .. .. 4 2 21 Urinary l0 7 3 .. .. 1 1 1 5 2 .. .. .. 3 7 Generative (Parturition) 3 3 .. .. .. .. 2 1 .. .. .. .. .. 3 Locomotory 2 2 .. .. 1 .. .. .. 1 .. .. .. .. .. 2 Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. IV. Developmental. Premature Birth, Low Vitality & Congenital 114 63 51 114 .. .. .. .. .. .. .. .. 2 11 101 Defects. Old Age 25 10 15 .. .. .. .. .. .. 9 16 .. 2 12 11 V. Violence 28 25 3 6 4 5 6 5 2 .. •• 1 3 24 VI. Illdefined and Illdefined 2 .. 2 1 .. .. 1 .. .. .. 1 1 Not Specified ( Not Specified 3 .. 3 .. .. .. .. .. .. .. .. Totals 1129 603 526 427 245 37 41 93 13b 114 25 4 38 145 942 31 In addition to persons dying in the sub-district, others die in various outlying institutions as shewn by Table III., and it is contended that such deaths should be included in order to shew the real death rate of the subdistrict, a very severe test, as many of these persons are merely members of families residing in East Battersea, being themselves resident and employed elsewhere, but when sick and admitted to institutions, giving the family address. These deaths numbered during the year under report 177 and if added to the number of persons dying within tho sub-district, will give a total of 1,306, equivalent to a death rate of 18.7 per thousand. This is 1.2 per thousand less than the mortality for the Metropolis, and then fails to eliminate great numbers who come from other districts to attend the Metropolitan Hospitals, and who are merely temporary sojourners in the sub-district, it being convenient and inexpensive. TABLE III. Deaths in Outlying Institutions. EAST BATTERSEA. Sex. Age. Institutions. Total. Male. Female. Under 1. 1 to 60. GO and upwards. Union Infirmary General & Special Hospitals. Asylums Board Hospitals. Disease. Small-pox .. .. .. .. .. .. .. .. .. Scarlet Fever 1 .. 1 .. 1 .. .. .. 1 Typhus Fever .. .. .. .. .. .. .. .. .. Enteric Fever 7 4 3 .. 7 .. .. 2 5 Whooping Cough 2 .. 2 .. 2 .. 1 1 .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases 11 6 5 .. 10 1 2 9 .. Tubercular Diseases 34 19 15 .. 30 2 17 16 1 Cancer 8 4 4 .. 7 1 3 5 .. Rheumatism 1 1 .. .. 1 .. .. 1 .. Respiratory Diseases 23 15 8 2 14 7 10 13 .. Circulatory Diseases 18 9 9 .. 15 3 7 10 1 Nervous Diseases 28 16 12 .. 18 10 11 15 2 Other Diseases 32 18 14 3 17 11 12 17 2 Violence 13 8 5 .. 13 •• .. 13 • • Totals 177 99 78 7 135 35 63 102 12 32 It will be observed by the above table that 63 persons died in the Union Infirmary, 102 in the general hospitals of the Metropolis, including the County and other lunatic asylums, and that 12 deaths occurred in the Hospitals of the Metropolitan Asylums Board amongst the persons removed thither during the year for infectious diseases. Ages at Under one year of age, 427 deaths took place, Death- being 37-8 per cent. of the total mortality. Between one and five years of age, 245 deaths were recorded, being equal to 2l.7 per cent. In all 672 deaths under five years of age were registered, being equal to 59.5 per cent. of the total mortality. Last year this was 564, and in 1884 the high per centage of 65.4 was reached. The average rate of deaths under five years has been for many years about 60 per cent. of the total number of deaths at all ages, and is an invariable accompaniment of a high birth rate, such as occurs in this sub-district which, like all others more recently inhabited, contains a young and vigorous population of child-producing age, in contrast to districts such as Kensington, with a birth rate of 22.6, and a death rate of 14.9; St. George's, Hanover Square, birth rate 20, death rate, 17.5; St. James'. Westminster, birth rate, 19.4, death rate, 19.3; and Hampstead, birth rate 24.7, and death rate 14.3. It will be seen that the death rate of the sub-district compares favourably with some of these favoured localities; but to place our mortality in a more equitable aspect it is well to refer to some other Metropolitan districts with large birth rates and deaths in proportion. Thus in St. Giles's the birth rate is 31.2, and the death rate 25.6; Bethnal Green 40.1 and 28.5; Whitechapel 37.2, and 28.9; and St. George's-in-theEast 39.2 births and 29.8 deaths per thousand. Now the birth rate for the sub-district as shewn in Table I. 53 has during tne last ten years, varied irom per tnousand to 36.2, and the extremes of the death rate have been 19.2 down to 16 per thousand. This conclusively demonstrates that notwithstanding the high birth rate which prevails in the sub-district, the healthful condition resulting from its excellent subsoil and large open spaces and the unremitting vigilance with which sanitary measures have been pursued by the Sanitary Authorities, have to a very great extent neutralised the tendency to a high death rate which is the result of a high birth rate. This would have been more distinctly apparent during late years but for the greater stringency with which children dying at, or soon after, birth, are now registered, it having been a common practice until lately to register children as stillborn who only lived for a short time after birth. Adult life has during late years been so enormously prolonged that probably but little remains to be done from the sanitarian's point of view in that direction, and any future diminution of the death rate can only arise either from a diminished birth rate or from a greater saving of life among the very young. The number of persons dying above 80 years of age was twenty-five—the number certified as dying of old age being the same. TABLE IV. Zymotic Mortality in the East Battersea Sub-district. 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 Small-pox 28 5 1 1 17 .. .. 3 1 .. Measles . 47 6 47 22 60 33 95 92 49 44 Scarlet Fever 18 19 44 63 20 36 17 17 3 9 Simple Continued Fever Enteric Fever 17 12 13 15 17 14 14 2 1 .. 3 8 10 Whooping Cough 26 63 39 43 37 56 53 60 47 62 Epidemic Diarrhœa Infantile Cholera 47 71 43 78 45 37 51 93 63 82 Other Zymotic Diseases . 22 20 25 13 18 11 19 20 13 24 Total Deaths from Zymotic Diseases 206 194 218 237 217 194 185 317 193 232 Zymotic Death-rate 4.3 3.7 3.9 4.3 3.7 3.2 3.0 4.9 2.8 3.3 Death-rate from all Diseases 19.2 17.3 17.0 18.9 16.8 16.4 16.5 18.5 16.0 16.2 34 Zymotic Diseases.—In Table IV. will be found a synopsis of the mortality which has occurred from infectious diseases during the past decade, the population of 1886 being 66,602; and that of 1876 about one-half that number. It is necessary to remember this to be able to judge fairly of the relative numbers. Small-pox caused no death in the sub-district. Three cases came under notice and were at once removed to the Hospital Ships, the premises and clothing disinfected with the result of absence of recurrence of the disease. It is much to be desired that the Metropolitan Asylums Board may be able to maintain the ships and the excellent arrangements for transference of patients thereto, instead of having recourse to the old system of inland hospitals which were proved to be centres of infection to the neighbourhoods in which they were situated. The cost of maintenance, now that the first outlay has taken place may be considered as a moderate premium of insurance against this dreaded, loathsome, and fatal disease. Epidemic Diarrhoea was the most fatal of the zymotic diseases during 1886, causing 82 deaths, some few cases being returned as infantile cholera, a distinction without any practical difference. The number of deaths from this disease always corresponds very closely with the duration of hot, dry weather, a lowered temperature or abundant rainfall at once arresting an epidemic. This points out the probability of the origin of the disease from decomposing organic matter, more especially such as is found in the modern system of house drainage into sewers, both of which latter require frequent and copious flushing. During its prevalence, drinking water and all food under the influences of high temperatures are found to prove to develope ptomaines or poisonous organic 35 alkaloids, the result of a partial or incipient state of decomposition, and to which the diarrhœa] epidemic is probably due. The majority of the victims, it is proper to state, were hand-fed infants. Whooping- Cough caused 62 deaths, the largest number since 1878, and has for the last four years been extremely prevalent. Measles was fatal in 44 instances, in many cases in conjunction with the preceding disease. Both these two diseases combined caused 106 deaths. There are the greatest practical difficulties in insuring isolation of those affected, the only means by which they could be effectively controlled, seeing the success which has attended isolation by removal to special hospitals in the case of Small-pox, Typhoid, Typhus and Scarlatina, for those for whom there is no means of isolation at home. It is certain that before long the popular intelligence will be educated to the point of insisting upon the effectual isolation of all affected by any infectious disorder. The result would be the saving of many lives and the prevention of a great amount of human suffering. Enteric Fever, caused 10 deaths, being much below the average. Sixteen cases came under cognisance, and where possible, were at once removed. Many other cases doubtless occurred in the private practice of medical men, of which no notice was received. Erysipelas caused 10 deaths also. Puerperal Fever, a cognate disease, caused the comparatively large number of 8 deaths. Scarlet Fever was fatal in 9 instances. This was until the last few years the most formidable of all the zymotic diseases, but the removal of cases where isolation was not possible has for some time past almost suppressed its manifestations. There are however, some symptoms indicative of a renewed outbreak, with which should it arrive, the Sanitary Authority will be at once enabled to deal. Diphtheria caused 6 deaths., and has like all this class of disease, become much less formidable and fatal than formerly, as the result of improved sanitation. Other Zymotic Diseases are but few in number and of comparative rarity. Other Diseases of the non-zymotic class.—Reference to table V. will illustrate the comparative prevalence of these diseases during 1886 compared with the years of the preceding decade. It will be observed that there is very little variation in the numbers if compared with the increase in the population, with the exeeption of a progressive decrease, which quite as forcibly as the decrease in the zymotic mortality points to a lowered death rate, and consequently to less sickness and prolonged life. TABLE V. Comparative Table of Deaths from Non-Zymotic Diseases for 11 years, 1876-86. Diseases. 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 Tubercular 205 193 116 167 248 173 192 175 213 181 202 Nervous System, Brain, &c. 67 32 110 97 110 128 112 119 128 104 120 Circulatory (Heart, &c.) 36 38 52 38 28 53 47 44 53 51 55 Respiratory 189 203 217 271 190 188 258 248 241 303 268 Digestive 35 32 33 32 41 39 22 42 22 36 27 Urinary 16 9 9 11 18 12 20 16 15 16 10 Generative, including Penturition 1 1 3 2 4 7 3 9 4 7 3 Locomotory, Bones, &c. 4 .. .. 3 1 .. 2 .. 4 3 2 integumentary .. .. 1 .. 5 1 1 .. .. 1 .. Premature Birth 66 67 45 55 69 67 63 74 lie 82 114 Uncertain Seat (Cancer, Syphilis, Dropsy, &c. 14 23 18 21 12 27 15 22 25 36 38 Old Age 13 16 9 20 22 14 18 21 19 22 25 Violence 32 26 25 26 33 24 30 24 18 32 28 Not Specified 9 9 13 17 12 11 14 24 9 4 5 Totals 687 699 701 760 793 649 798 818 867 878 397 37 Deaths not Certified. The number of deaths not certified by a registered medical practitioner was nineteen, exactly the same number as in the preceding year. Eleven were submitted to the Coroner, who decided that in the respective circumstances an inquest was unnecessary; the remaining eight cases were attended by midwives, and not submitted to the Coroner or any other authority, but registered as follows:— Age 1 day .. Convulsions. ,, 11 hours .. Premature Birth. „ 20 „ .. do. „ 1 day .. do. „ 1 „ .. do. ,, 2 ,, .. do. „ 12 hours .. Convulsions. ,, 22 ,, .. Exhaustion after protracted labour. Inquests were held by the Coroner in sixty instances, in addition to investigation of the nineteen cases mentioned above. Seven per cent. of the total deaths were included in the total number of seventy-nine cases which were therefore not registered in the usual manner by medical certificate. inquests. Sixty inquests were held in 1886, a considerable increase on the number of the preceding year— forty-five—and much above the average. The respective verdicts of the Juries were:— From Natural causes 29 From Accidental causes— Asphyxia (infants) 7 Drowned 9 Concussion, Fracture, &c. 4 Killed on Railway 3 Septicœmia from injury 1 Tetanus from injury 1 — 25 Homicidal— Poison—Opium—Manslaughter, 1, Suicide 1, 2 „ Hydrochloric Acid, Suicide 1 Drowned, Suicide 1 — 4 Found Dead, newly-born 2 60 38 The proportion of inquests to deaths was 5.3 per cent. The deaths of the infants who were asphyciated were recorded as having taken place upon the following days, and at the ages here given:— Thursday, Dec. 31, 1885 Age 1 year. Friday, Jan. 31, 1886 7 weeks. Saturday, Feb. 1, „ 4 ,, Tuesday, Mar. 2, ,,3 months. Friday, „ 5, „ 3 „ Friday, „ 19, „ 8 days. Thursday, Nov. 11, 2 months. Sunday, Dec. 5, ,, 7 weeks. Vaccination. The following gives the number of cases successfully vaccinated and re-vaccinated by the Public Vaccinator during 1886, and is compiled from the official register. Primary Vaccinations 1250 Re-vaccinations 29 Total 1279 No case of small-pox has yet been known to occur in any person vaccinated at the public vaccination station, although such an occurrance has been looked for in every case of the disease which has come under notice. Social Position. The steady increase in the professional and trading classes in the sub-district is shewn by the constantly-increasing proportion of deaths in persons belonging to those classes. The gentry diminish year by year as do the working classes relatively. In 1886 the following deaths were registered of such persons:- No. Per cent. Nobility and Gentry 4 = 0.35 Professional Classes 38 = 3.37 Middle and Trading Classes 145 = 12.84 Industrial and Labouring Classes 942 = 83.44 Totals 1129 100.00 39 Sanitary Operations. (See Table, page 22). The sanitary work of the past year shews that 7,711 houses have been inspected ; and that the number of notices served continues to increase year by year. During 1886, 848 first notices were served to remedy 2,156 sanitary defects, against 617 like notices in 1883. Of second notices to enforce such works before taking proceedings, 119 were issued and served in contrast with 188 in the previous year, shewing that owners comply with the Board's requirements more readily each year. The ill-concealed aversion with which the domiciliary visits of the Board's Inspectors were received a few years ago has given way to a knowledge of the fact that their visits are for the assistance and protection of the poor, in what would otherwise probably be as of old, unhealthy conditions of houses, drainage, water supply, &c., &c. All classes now welcome the visits of the sanitary inspectors, and afford them every possible information and assistance, with scarcely an exception. Out of the large number of cases mentioned above it was only necessary to invoke magisterial aid on six occasions, in each of which orders were made and the works executed. The number of houses disinfected after the existence of infectious diseases was 73—in the preceding year 269 houses being so treated—in itself an illustration of the smaller amount of epidemic disease existing in 1886 as compared with the former year. No case was found to recur after such disinfection, which could be in any way traceable to failure of the method of disinfection by sulphurous acid gas, which has been in successful use in the sub-district for many years, and which time has proved superior to and less expensive than any other method. Filthy and unserviceable bedding was destroyed by fire in two instances. 40 Several cases of overcrowding, in all 19, apparently in every case the direct consequence of poverty, were discovered by the visits of the Sanitary Inspectors. In every case the order to discontinue such overcrowdingwas enforced. Drains requiring clearing, cleansing and repairing to the number of 384, have received the necessary attention, and 188 syphon traps have been fixed to the same in order to prevent the access of sewer gas to houses, and 59 sinks have had their connexion with drains cut off by being altered so as to discharge outside the houses over open gullies. Water closets have been found to be out of order with great frequency, more especially in the poorer parts of the sub-district. Cleaning and repair in 43 cases have been enforced, many others having but minor defects which were remedied without notice being necessary. The large number of 383 water-closets have had a supply of water laid on, those not so supplied now being very few indeed. Six urinals have been similarly supplied in addition to repairs and cleansing. Dust-bins have as usual been a continual source of trouble, being frequently destroyed in the poorer neighbourhoods, and in 187 instances replaced by new ones. It is to be hoped that the measures now being adopted to deal with the question of the removal and disposal of house refuse in Battersea will increase the frequency of collection, so that dust-bins with their accompanying annoyances and sanitary defects may become superfluous and no longer needed. A systematic collection of house refuse once or twice a week would be a great boon to all classes, and an inestimable benefit from a sanitary point of view. 41 Unwholesome and dilapidated houses have been cleansed and repaired during the year to the number of 84, in addition to which 58 dirty rooms have been cleansed and made habitable, besides 23 staircases and passages which were in a filthy condition. Also 66 leaky house roofs and gullies have been made good, 27 houses supplied with water, and the large number of 471 water-cisterns covered andrepaired. Nearly the whole of these numerous works have been carried out at the expense of the owners of property, and arc evidence of the interest taken in the dwellings of the poorer classes in the sub-district by the sanitary authority and its officers, and have been the result of much care and exertion, necessitating frequent re-inspections and close supervision. Reference was made in the report for 1885 to the great necessity for improved ventilation for the sewers by means other than surface ventilators. Much has since been done in this direction by upcast shafts affixed to the sides of houses in proper positions. Of the efficacy of the system there can be no doubt, as a stream of evil smelling sewer gas constantly flows from the opening at the summit. Many practical men, members of the Board and others, who were doubtful of the result of attempting to ventilate the sewers by this means, having convinced themselves by experience, are now amongst its most earnest advocates. The Metropolitan Board of Works has now adopted this method of ventilating the Bridge Road sewer, and the engineer in charge has expressed his satisfaction at the result, and is prepared to erect shafts at other points where available. Much credit is due to Mr. Pilditch, the Surveyor for the method of construction by which he collects the 42 gases so that their pressure is exerted upon the interior of the outcast shafts and a steady and continuous outflow ensured. Amongst the prosecutions undertaken at the Police Court by the Board's order, the following are of interest and importance. A pork-butcher in the Battersea Park Road was fined £20 and £3 5s. Od. costs for having the carcase of a diseased pig prepared for human food upon his premises. The pig in question was suffering from swine fever, and would but for the prompt action of Chief Inspector Richards, have in all probability been speedily disposed of for human food, and with possibly serious results, as the flesh of swine suffering from this disease is apt to cause severe illness. A costermongcr from Bermondsey was fined £10 and £2 2s. Od. costs for having prepared for human food the carcase of a diseased bullock. Mr. Richards in this case made the seizure just in time to prevent the meat being disposed of for human food. These cases should for the future be dealt with by more severe punishment, as much illness and many deaths have in the past been caused by the sale and consumption of the flesh of diseased animals, indeed it is urged by many scientists that a largo number of the diseases which affect the human body are thus derived. The dust depots in the parish have been constantly inspected and their condition reported upon at each meeting of the Local Committee. Their condition generally has been better than heretofore, but their entire abolition is much to be desired, and will doubtless obtain in time. 43 Mr. Covington's depot, adjoining the Southwark and Vauxhall Water Company's premises, has been removed to the other side of the railway at a much greater distance than before. Cow & slaughter- These have been periodically inspected and have been found cleanly and well conducted, and have been lime-whited at the proper time. There has been no necessity for opposition to the renewal of any license. The only offence in contravention of the regulations was committed by a cow-keeper who used his premises as a slaughter-house, the same not being so licensed. He was prosecuted by the Board's order and fined 40s. and costs. The bakehouses were inspected, found in good order, and with no ground for complaint. The articles destroyed as unfit for human food have not been numerous this year, the close supervision exercised over the street salesmen having rendered them apparently very careful as to the condition of the goods they offer for sale in this parish. They comprised 500 herrings, 120 smoked haddocks, 8 stone of plaice, 108 mackerel, 6 boxes of kippered herrings. I have again to express my acknowledgment of the great and unvarying support I have received from the members of the Board generally, and more especially from those constituting the Battersea Local Committee, in the discharge of the duties of my office, and hope that I may be fortunate enongh to receive like assistance in the future to that which has been extended to me in the past. The condition of the sub-district which I have been enabled to lay before them in this report is the 44 best evidence that their exertions, as the sanitaryauthority of the District, have been of the greatest value to its inhabitants, whether judged by the death rate, the amount of sickness, or any other test which can be applied to the health-condition of a district. To Mr. Pilditch, the Surveyor, I have again to express my thanks for his ready and valuable assistance upon all occasions. Of Mr. Richards, the Chief Sanitary Inspector, I cannot speak too highly, and I feel certain that the parish is fortunate in possessing such an efficient officer. His assistants, Mr. Freeman and Mr. Poole, have given me much satisfaction during the past year by the energetic and capable manner in which they have fulfilled their duties. W. H. KEMPSTER, M.D., Medical Officer of Health for East Batter sea. 45 WEST BATTERSEA. The excellent condition of health which has prevailed in this sub-district for years past has been more than maintained during the year 1886 now under report, for taking the mortality as a whole, there is a decrease of 47 as compared with 1885. Further, on comparing the zymotic mortality, which represents the sanitary condition under which we live, there is a decrease of 68 on that year, and a death rate from this class of disease, which is the lowest that has prevailed for the past ten years. I believe it is the constant supervision over all sanitary matters, the regular house to house inspection always going on, the immediate attention given to all complaints, and the speedy removal of infectious sick persons to hospital, which conduces very materially to the lowness of the mortality from infectious disease. The ambulance system of the Asylums Board may be said to be as perfect as it well can, for not more than two or three hours elapse after notice is sent before the ambulance, with every comfort, is at the patient's door. It would much facilitate removal, if all medical men were empowered to fill in the necessary certificates, and in the absence of compulsory notification of infectious disease, to be requested to communicate the fact to the sanitary authorities. That there has been a great diminution in infectious cases is shown by the number of houses disinfected as compared with last year, when it was 169; this year it is 54. This is satisfactory, as it is against this class of disease that sanitarians are constantly at work. Population. The population estimated on the basis proposed by the Registrar-General for the middle of the 46 year would be 67,265. This I think is too low, as it gives a birth rate of 39 per 1000, being 6.7 more than that of London, which was 32.3 per 1000. Mortality. The total number of deaths returned by the Registrar as having taken place in this sub-district was 1,348—of which 682 were males and 666 females. In 1885, 1,395 were returned; there is therefore a decrease of 47 on that year. In addition to the above, 63 took place in public institutions outside the district, making a total of 1,411 persons who died in and connected with this division of the parish. Of the 1,348, 272 occurred in institutions within the sub-district, viz:—261 in the Infirmary and 11 in the Bolingbroke Hospital; these are 3 above those of the previous year, when 269 were returned. Of the deaths which took place in the Infirmary, 64 belonged to West Battersea, the remainder to other divisions of the Union. Deducting the 272 deaths in public institutions, 1,076 will be the correct number for this out-door district.* The number of deaths registered in each quarter of the year was as follows:— First Second Third Fourth Quarter. Quarter. Quarter. Quarter. 426 301 319 302 Total deaths from all causes, including all deaths in the Infirmary in the respective years were:— 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 854 820 908 1002 1010 1195 1222 1341 1319 1395 1348 *Out-door with reference to Infirmary. 47 The deaths in the Infirmary were 261—males, 144; females, 117. The death rates per 1,000, including Infirmary deaths belonging to this sub-district and outlying Institutions:— 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 19.5 17.1 18.5 20.0 16.8 19.0 18.0 18.6 18.8 19.8 18.1 The deaths during the past year, not including those occurring in its Institutions, nor those in outlying Institutions, numbered 1,076; these give a death rate of 15.9 per 1,000. Birthrate. The number of births registered were 2,617, of which 1,356 were males and 1,261 females, being a difference of 95 in favor of the males, and an increase of 59 above those of the previous year. The rate is 39. per 1,000, being 2 per 1,000 more than that of the census year, at the same time the same increase of population as in the preceding decennial period has been allowed. The return for each quarter was as follows:— First Second Third Fourth Quarter. Quarter. Quarter. Quarter. 709 645 646 617 Natural The above number of births are 1,477 in ncreasc. excess of the deaths,and constitute the year's natural increase. 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:— 48 TABLE I. WEST BATTERSEA Population (Census) 1881 52,587 Official Population in middle of June, 1886 67,265 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. obility and Gent r Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. | Industrial and Labouring \ Classes. I. Zymotic. a Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 26 14 12 4 21 1 .. .. .. .. .. .. 1 6 19 Scarlet Fever 5 2 3 .. 5 .. .. .. .. .. .. .. 1 .. 4 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 13 6 7 .. 2 .. 2 4 4 1 .. .. .. 5 8 Puerperal Fever 1 .. 1 .. .. .. .. 1 .. .. .. 1 .. .. .. Diphtheria 3 2 1 .. 2 .. 1 .. .. .. .. .. .. .. 3 Whooping Cough 42 16 26 24 17 1 .. .. .. .. .. .. 1 2 39 Erysipelas 6 3 3 .. .. .. 1 .. 2 3 .. .. .. 1 5 Diarihœa, Dysentery, and Cholera 70 41 29 54 7 .. .. 4 1 3 1 .. 2 9 59 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 166 84 82 82 54 2 4 9 7 7 1 1 5 23 137 n. Constitutional. Gont and Rheumatism. 13 10 3 .. .. 1 1 4 1 5 1 .. .. 2 11 Cancer & other Tumours 33 15 18 .. 1 .. .. 4 15 13 .. 2 .. 5 26 Other Constitutional Diseases 5 2 3 .. 1 .. 2 .. 9 .. .. .. 1 .. 4 r Tubercular Phthisis 114 61 53 1 1 1 15 49 35 11 1 1 4 11 98 Tabes Mesa 92 43 49 70 13 .. 9 5 2 .. .. 2 2 10 78 Hydrocephalus 23 14 9 9 9 3 1 1 .. .. .. .. .. 2 21 Scrofula 8 6 2 7 .. 1 .. .. .. .. .. .. .. 2 6 III. .Local. Nervous 169 89 80 54 19 1 3 9 28 48 7 5 8 16 140 Circulatory 104 53 51 4 .. 2 3 6 37 46 6 3 & 11 85 Respiratory 315 153 162 84 54 4 5 16 46 91 15 10 8 40 257 Digestive 69 34 35 14 3 2 4 4 24 18 .. 3 6 16 44 Urinary 21 10 11 .. .. 1 .. 5 9 5 1 2 1 2 16 Generative 11 .. 11 .. .. .. .. 9 9 .. .. .. .. .. 11 Locomotory 18 11 7 4 .. 1 3 3 3 4 .. .. .. 2 l6 Integumentary 6 1 5 .. 1 1 .. .. 1 3 .. .. 1 .. 5 IV. Developmental. Premature Birth and Low Vitality 61 36 25 60 1 .. .. .. .. .. .. .. .. 4 57 Congenital Defects .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 74 29 45 .. .. .. .. .. .. 39 35 2 1 8 63 V. Violence 35 25 10 7 .. 2 3 14 5 4 .. .. .. 1 34 VI. Illdefmed and ( Illdefined Not Specified ( Not Specified 11 6 5 6 .. 3 .. .. 2 .. .. .. .. 2 9 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1348 682 666 402 157 25 46 138 219 294 67 31 42 157 118 Including all deaths in the Infirmary. 43 Zymotio Mortality. The deaths from this class of disease were 166, of which 84 were males and 82 females, and are 68 less than those of the previous year. The greatest fatality was from Whooping-cough, Diarrhœa, and Measles, which collectively gave 138 of the total number. There is, compared with last year, a decrease in Whooping-cough and Measles, and an increase of Diarrhœa. From Fevers other than Scarlet and Measles there were 14 deaths, classified as follows:— Typhoid or Enteric 13 Puerperal 1 14 Of the total number 82 were under 1, 54 from 1 to 5 years of age, 6 from 5 to 20, and 24 from 20 upwards. No less than 136 of the total 166 were under 5 years of age, clearly showing the ages most susceptible to this class of disease. The following table contrasts all deaths from zymotic causes during the past 10 years ; also the death rate:— TABLE II. Zymotic Mortality in the West Battersea Sub-district. 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 Small Pox 13 2 2 .. 4 1 .. 2 1 .. Measles 8 34 43 8 50 30 52 42 63 26 Scarlet Fever 8 4 00 30 25 35 26 14 5 5 Diphtheria 2 4 7 3 9 4 2 11 2 3 Enteric Fever 25 15 27 10 10 14 12 20 9 13 Whooping-Cough 18 36 11 23 31 47 46 46 74 42 Epidemic Diarrhœa 22 41 17 61 53 39 64 82 63 70 Other Zymotic Disease 11 11 12 11 16 24 16 34 17 7 Total Deaths from Zymotic Diseases 107 150 174 146 198 194 218 251 234 166 Zymotic Death rate 2.8 3.8 4.2 2.9 3.8 3.6 3.6 4.0 3.6 2.4 Death rate from all Diseases 17.1 18.5 20.0 16.3 19.0 18.0 18.6 18.8 19.8 18.1 60 Other causes of Death than Zymotic. From these classes 1,182 deaths were returned, being 21 in excess of those of last year. There were 187 from Bronchitis, Pneumonia, 86. Other Lung Liseases, 42; from Circulatory Disease, 104, Brain and Nerves, 169; Digestive Organs, 69; Premature Birth, Low Vitality, 61; Old Age, 74; Cancer, 33; Violence 35, &c. Cancer, Premature Birth, Old Age, Violence, and disease of Digestive Organs, show an increase as compared with last year, whilst those of the Respiratory Organs, Brain and Nerves, a slight decrease. From the Tubercular Class, 237 Avere returned, viz:— Phthisis, 114; Tabes Mesenterica, 92; Scrofula, 8; and Hydrocephalus, 23. Of those from Phthisis, 18 were under 20; and 84 from 20 to 60 years of age. In analysing the mortality of the respective sexes in this class of disease (Phthisis), it would appear that females die at a greater rate than males, between the ages of 20 and 40—30 out of a total of 49 being females, whilst in the next 20 years, 40 to 60, the males die at a far greater rate, for out of 35 deaths, only 6 were females. The deaths from old age were 74, against 54 of last year, the eldest being females—97, 96, 92, 90, 90, 90, whilst four males reached the great age of 96, 95, 92, and 90 years respectively. Revorting now to the opposite extremes of the duration of life, we find that in 4 instances it was a few minutes—20; a few hours, and in 74 a few days. The following table (III) contrasts all deaths from non-zymotic causes during the past 10 years. 51  1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 Tubercular, including Phthisis.. 172 143 163 196 210 198 255 266 239 237 Of Brain, Nerves, &c. 148 137 136 117 147 173 168 170 178 169 Of the Heart, &c. 55 53 56 72 94 83 85 95 108 104 Of the Respiratory Organs, excluding Phthisis 124 204 260 215 266 272 318 248 327 315 Of Digestive Organs 37 27 27 47 59 59 68 63 52 69 Of Urinary Organs 14 16 20 15 26 21 32 19 30 21 Of Organs of Generation 8 3 9 9 14 14 11 12 16 11 Of Joints, Bones, &c. 1 2 2 3 15 12 19 12 5 18 Of Cancer 22 23 14 22 21 25 33 17 31 33 Premature Birth, Low Vitality Malformation, &c 30 31 36 70 37 78 30 33 55 61 Of Uncertain Seat and other diseases 25 29 17 36 27 27 13 39 29 24 Age 47 58 57 35 31 37 64 45 54 74 Violence 23 28 13 23 40 30 20 39 29 35 Constitutional 7 11 16 4 10 6 7 10 8 11 Totals 713 751 828 864 997 1028 1123 1068 1161 1182 Of the 1,182 deaths, 593 were those of males and 584 of females. The causes of death of persons dying without the district will be found in the table following; they were 63 in number. TABLE IV. 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 .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. Enteric Fever 2 1 1 .. 2 .. .. 1 1 Diphtheria 3 2 1 .. 3 .. .. 3 .. Whooping Cough .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases .. .. .. .. .. .. .. .. .. Tubercular Diseases 9 7 2 .. 9 .. .. 8 1 Cancer 3 2 1 .. 1 2 .. 3 .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 14 10 4 .. 13 1 .. 14 .. Circulatory Diseases 10 6 4 .. 10 .. .. 10 .. Nervous Diseases 7 5 2 .. 4 3 .. 7 .. Other Diseases 10 6 4 1 8 1 .. 10 .. Violence 5 4 1 .. 3 2 .. 5 .. Totals 63 43 20 1 53 9 .. 61 2 Those occurring in Institutions within the district are included in the General Mortality table. 62 Inquests. Enquiries were held on the bodies of 39 males and 25 females, in all 64, being 9 more than those of the previous year. The verdicts were as follows:— From Natural Causes 32 „ Accidental 19 Found Drowned 3 „ Dead 4 Suicide 6 64 Of the Accidental causes—3 by falls, 3 from burns, 4 suffocated in bed, 7 drowned in the Thames, 1 run over, 1 fractured skull. The suicides were respectively—2 by poison, 1 by shooting, 2 cut-throats, 1 hanging. Of the found dead, 2 were on the railway, 1 a newly born infant on Clapham Common, and a verdict of wilful murder was returned against some person unknown on the body of a newly-born female child found with its throat cut, in Bolingbroke Grove. In addition to the above inquests, 28 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 3, and occurred on the following dates:— Monday, September 20th. Saturday, December 25th. Sunday, December 26th, Social Position. The per-centage of deaths, in relation to social position is as follows:— Nobility and Gentry 31=2.300 Professional 42=3.116 Middle and Trading Class 157=11.646 Labouring 1118=82.938 1348=100.000 53 Diseases and Mortality amongst the Union Poor. The number of cases which came under treatment was 686, being 76 in excess of the previous year. Indeed there has been a tendency to increased numbers for the last five years. In Table III. will be found the nature of the illness these persons suffered from. Of the above number 27 died, giving a death rate of 3.9 per cent. Dispensary. A new Parochial Dispensary with residence and offices fox the Relieving Officers of East and West Battersea, has been erected in Latchmere Road, situate about the centre of the two districts, an arrangement which will have many advantages for the poor, as the relief officers and the medical officers will attend at the same hour, and thus save the long distance most of the patients have to travel at the present time. It is expected to be in working order by the June quarter. Sanitary Matters. Sanitary operations have been carried out during the year with the usual vigour. On reference to the Table of Sanitary matters (page 22), it will be seen that 8,178 houses were inspected during the year, which shows that nearly all the houses in the district are kept under the Inspector's observations once within the year. These inspections brought to light 1,782 defects, which 830 notices were served to remedy. Of these, 685 were complied with; in the remainder 145 second notices were served, and in only 7 instances was it necessary to apply to the Magistrate to enforce compliance. The number of drains cleansed and repaired was 376 more than in the previous year. Water Supply. To 405 closets, water was laid on. In 18 cases notice was received from the Water Company that certain houses were without water supply. On enquiry it was found that the water had been cut off by the 54 company through the non-payment of the rate; they then sent notice of no supply to the Board, and so endeavour to make it through the Sanitary Act the means of enforcing payment of their claims, and to compel the tenants to repair that which they themselves have directly destroyed. I question if the legislature ever contemplated the Act being used for such a purpose. Cisterns. The large number of 245 cisterns were covered or recovered during the year, including many situated under the floor boards of the room where they are placed, thus preventing any matters during sweeping or cleansing finding their wav into them. The same remarks apply equally to those situated immediately under the roofs of houses. The best remedy for these imperfect arrangements would be a constant supply, and so do away with any contamination the storage of water in cisterns is liable to. Overcrowding. Six cases of overcrowding came under notice, in two of which proceedings were ordered to be taken. In the first case, living and sleeping in one room was father, mother, two sons aged 21 and 25 years, and two daughters aged 12 and 17 respectively. In the second case, father, mother, two children, and two men lodgers lived and slept in the same room. Meat Unfit for Food. About 200 pounds of beef was seized from a shop in the York Road, where it had been placed in pickle. Proceedings were taken. Every effort was made by the defendant to overthrow the evidence of your officers. The Magistrate was however satisfied that the meat was quite unfit for food, and that it was intended for sale. The defendant was fined £40 55 The undermentioned articles were destroyed by the Nuisance Inspector as being unfit for food:— 120 Pairs of kippered herrings. 140 Mackerel. 100 lbs. Currants, 4 Bushels of Cherries. Bakehouses. These have been kept under constant supervision, and are all in good condition. Two new ones were opened during the year, neither of which complied with the requirements of the Act. Notices were served and the necessary alterations carried out. Cow and Slaughter-Houses were all inspected. They were found to be in good order, and in no case was it necessary to oppose the renewal of the licence. Mortuary. The Mortuary has been used more extensively this year than ever. The bodies of 108 persons were placed in it, far more than sufficient to prove its necessity. The condition in which it is kept is good. I have to express my satisfaction with the manner in which the several Inspectors have carried out their duties. Mr. Richards, as heretofore being most energetic, using every endeavour to maintain the condition of the district as being one of the best inspected in the whole of the Metropolis. J. OAKMAN, Medical Officer of Health for West Battersea. 56 CLAPHAM. The following report requires but few words of introduction. The tables of mortality (page 59 and 60), and of sanitary work executed (page 22), give in a succinct form the causes of death which are in operation, and the efforts made to diminish the incidence of preventible diseases. The year 1886 was on the whole a healthy one, and the general deathrate was lower than in any except the last preceding year. One striking feature of the year's sanitary history was the complete absence of Small-Pox. Another important point is the increasing number of persons who apply to have their houses disinfected after the occurrence of infectious diseases, or to have an inspection made for the detection of suspected nuisances. Such cases are unfortunately still in a small minority; but there is abundant evidence that the public is beginning to regard the visits of the sanitary inspectors not as an inquisition into their private affairs, but as a necessary safeguard to health. The educative value of the sanitary inspections made on the householders of Clapham should not be forgotten in any estimate of the sanitary work executed during the year. 57 Population. The official method of estimating the population in any year between two census enumerations, is based on the assumption that the rate of increase is the same as in the previous decade. Accepting this basis of calculation, the estimated population of Clapham for the middle of 1886 is 41,945. It is highly probable, however, that the population of Clapham has increased in a much greater proportion since 1881 than in the ten years before that period, and that the death rates, &c., are therefore really lower than appears on the basis of the official population. Births and Birth rate. The number of births registered during 1886 was 1,071, of which 530 were boys and 541 girls. The annual birth-rate was 25.53 of the estimated population (see Table I.), which with the exception of last year, was the lowest for ten years. The birth rate for the whole Metropolis was 32.3, which was the lowest since the year 1850. This considerable diminution in the birth-rate must be allowed to have had some influence in producing the very favorable death rate of Clapham. A low birth rate is necessarily followed by a smaller proportion of children under 5 years of age; and as will be afterwards seen, the mortality at these ages is higher than at any subsequent period of life. The low birth-rate by no means however completely accounts for the low death-rate, which must be chiefly ascribed to improved vital conditions of the sub-district. Deaths and Death-rate. During the year 1886,545 deaths—255 of males and 290 of females, were registered in the sub-district. These are equivalent to an annual death 58 rate of 12.99 per 1,000, the lowest hitherto recorded, with the exception of the previous year (see Table I.) The death rate for the whole of the Wandsworth District during the same period was 17.06, for the whole of South London, 19.2, and for the whole of London, 19.9 per 1,000 of the population. The natural increase of the population of Clapham, i.e., the excess of births over deaths was 526, giving a rate of 12.5 per thousand. TABLE I. Birth and Death rates. YEARS. Births. Birth rate. Deaths from all Causes. Death rate. Rate of Natural Increase. 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 10,85 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 1886 1,071 25.53 545 12.99 12.5 Deaths in Out-lying Institutions. The deaths already enumerated do not include those of inhabitants of this sub-district 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, 76 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. 59 TABLE II. Deaths in 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 .. .. .. .. .. .. .. .. .. Scarlet Fever 1 1 .. .. 1 .. .. .. 1 Diphtheria 1 .. 1 .. 1 .. .. 1 .. Enteric Eever .. .. .. .. .. .. 1 .. .. Whooping Cough 1 .. 1 .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases .. .. .. .. .. .. .. .. .. Tubercular Diseases 10 6 4 .. 10 .. 6 4 .. Cancer 4 1 3 .. 2 2 1 3 .. Rheumatism 1 1 .. .. .. 1 1 .. .. Respiratory Diseases 10 8 2 .. 7 3 6 4 .. Circulatory Diseases 14 7 7 .. 8 6 9 5 .. Nervous Diseases 8 7 1 .. 6 2 3 5 .. Other Diseases 23 14 9 3 10 10 12 11 .. Violence 3 2 1 1 2 •• •• 3 Totals 76 47 29 5 47 24 39 36 1 It will be seen that 39 of the external deaths occurred in the Wandsworth and Clapham Union Infirmary, 36 in various hospitals, and only 1 in the Asylums Board Hospitals. If these 76 deaths be added to the 545 occurring in Clapham, the death-rate becomes 14 80 per 1,000, as compared with 14.32 in the preceding year. This remarkably low inclusive death-rate bears out the statements already made as to the excellent vital condition of Clapham during the past year. Deaths occurring in Clapham. In the following table the deaths registered as occurring within Clapham are classified according to cause, age, sex and social position; and a more detailed list is given of the deaths from zymotic diseases. 60 STATISTICS OF MORTALITY. CLAPHAM. Total deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Population (Census) 1881 36,380 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 1886 41,945 CAUSES OF DEATH. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. I. Zymotic. Measles 11 7 4 2 7 2 .. .. .. .. .. .. 1 4 6 Scarlet Fever 1 1 .. .. 1 .. .. .. .. .. .. .. .. .. 1 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 3 2 1 .. .. .. .. 3 .. .. .. .. .. .. 3 Puerperal Fever 2 .. 2 .. .. .. .. 1 1 .. .. .. .. .. 2 Diphtheria 6 6 .. 1 2 2 1 .. .. .. .. .. 1 2 3 Whooping Cough 34 12 22 16 17 1 .. .. .. .. .. .. 3 3 28 Erysipelas 2 1 1 1 .. .. .. .. .. 1 .. 1 .. .. 1 Diarrhœa, Dysentery, and Cholera 25 12 13 21 3 .. .. .. .. .. 1 1 4 6 14 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 84 41 43 41 30 5 1 4 1 1 1 2 9 15 58 II. Constitutional. Gout and Rheumatism 3 1 2 .. .. .. .. 1 1 1 .. .. .. .. 3 Cancer & other Tumours Other Constitutional 23 6 17 .. .. .. .. 2 12 8 1 3 6 7 8 Diseases 6 3 3 2 1 .. .. 1 2 .. .. .. 1 1 4 Tubercular Phthisis 42 23 19 2 1 1 6 16 13 3 .. .. 8 11 23 Tabes Mesa 21 11 10 11 7 .. 1 .. 2 .. .. .. 3 3 15 Hydrocephalus 14 10 4 8 5 1 .. .. .. .. .. .. .. 1 13 Scrofula .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. III. Local. Nervous 79 42 37 20 10 2 3 5 9 24 6 9 10 18 42 Circulatory 35 9 26 1 .. 2 2 2 11 16 1 6 4 5 20 Respiratory 103 52 51 23 22 2 .. 6 10 31 9 7 16 23 57 Digestive 39 16 23 11 1 .. 1 3 13 9 1 3 6 12 18 Urinary 16 9 7 1 .. .. .. 2 8 4 1 .. 5 6 5 Generative 5 .. 5 .. .. .. .. 5 .. .. .. .. 1 1 3 Locomotory 1 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. IV. Developmental. Premature Birth & Low Vitality 28 17 11 28 .. .. .. .. .. .. .. .. 2 5 21 Congenital Defects .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Old Age 33 10 23 .. .. .. .. .. .. 10 23 4 9 7 13 V. Violence 12 6 6 5 2 .. .. 1 2 2 .. .. 1 4 7 VI. Illdefined and Not Specified Illdefined Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. 1 .. .. .. 1 Totals 545 255 290 153 79 13 15 48 84 109 44 34 80 119 312 61 Ages at Death. Of the total deaths, 47.7 per cent. occurred at various ages under 20 years, 28 per cent. being under 1 year, and 14.4 per cent. between 1 and 5. In the preceding year 42.8 per cent. of the total deaths occurred at ages below 20, 24.5 per cent. under 1 year, and 12.8 per cent. between 1 and 5. Infantile Death-rate. The proportion of deaths under 1 year to total deaths obviously will vary with the birthrate. 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 InJantile death-rate. In Clapham this was 142 per thousand births, as compared with 120 in the preceding year, and with 159 for the whole Metropolis during 1886. The increase of infantile mortality was chiefly due to the higher mortality from Diarrhœa at this age, 21 deaths as compared with 11 in the previous year. Senile Mortality. The deaths of persons over 60 years formed 28 per cent. of the total deaths, as compared with 29 per cent. in the previous year. 24.2 per cent. of the total deaths occurred between 20 and 60 years of age, as compared with 29.6 per cent. in the previous year. Social Position of Deceased. The relative number of deaths in the several social grades were as follows:— Nobility and Gentry 34=5.5 per cent. Professional Class 80=14.6 „ Middle and Trading Class 119=21.8 ,, Industrial and Labouring Class 312=57.1 ,, 62 In the absence of knowledge of the proportionate population belonging to etch of these classes, it is impossible to state their separate death rates. It is important to note however, that while the industrial classes only furnished 57.1 per cent. of the total deaths, 69 per cent. of the total deaths from zymotic diseases belonged to them. Zymotic Diseases. The following table gives the number of deaths from specific fevers, as compared with previous years, and a similar comparison of zymotic and general death-rates. The zymotic death-rate was 2 per 1,000. or including the 3 deaths in external institutions, 2.07 per 1,000 of the estimated population. The corresponding rate for the whole Metropolis was 2.69 per 1,000. TABLE IV. Zymotic Mortality in Clapham. 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 Small-pox 12 3 .. 2 7 1 .. 2 .. .. Measles 5 23 17 19 10 15 33 33 3 11 Scarlet Fever 4 12 12 21 15 26 8 3 .. 1 Diphtheria .. 3 1 3 3 4 7 8 4 6 Enteric Fever 4 5 9 4 3 7 3 4 8 3 WhoopingCough 12 29 25 25 13 17 16 15 25 34 Epidemic Diarrhœa 18 26 17 36 20 4 19 18 16 25 Other Zymotic Diseases 9 9 21 9 7 7 26 12 5 4 Total deaths from Zymotic Diseases 64 110 102 119 78 81 112 95 61 84 Zymotic Deathrate 2.0 3.4 3.1 3.4 2.1 2.1 2.9 2.3 1.49 2.00 Death-rate from all Diseases 14.8 18.1 17.0 14.9 13.5 14.5 15.1 13.7 12.4 12.9 63 No deaths from Small-pox occurred in Clapham during the year, and no cases of this disease were admitted from Clapham into the Asylums Board Hospituls (21 in the previous year). Measles, for which no isolation hospitals are provided, caused 11 deaths, and Whooping Cough 34 deaths. There was only one death from Scarlet Fever, and that from a remote complication of the disease. 59 cases of Scarlet Fever of a mild type came under our notice in 40 houses, and 2 cases in the Victoria Hospital for Children; the latter having been removed from this neighbourhood a considerable period before they acquired the disease. Particulars of some of Scarlet Fever Cases. 33, Thurlow Street. A boy 3½ years was brought down stairs each day by the mother during illness, and a few days later two other children started with the disease. 12, Heath Road. A girl 4½ years. Fifteen days before this case started, the drains of the house were found to be defective, and a notice served on the owner or occupier. The work was not executed till some days after the patient's removal to hospital. 123, Heath Road. A boy 3 years and girl at 5 years. An older sister attended Tennyson Road Board School, and sat next a girl who was attending school while peeling after Scarlet Fever. Crichton Street. Two children at No. 1, one child at No. 3, and one at No. 19 came in contact with and 64 parently received infection from a girl recovering from Scarlet Fever at No. 16. 4, Courland Grove. This child had three cousins in Southville who died from Malignant Scarlet Fever a few days previous. 8, Rectory Grove. A boy 2½ years. Found other children from this house attending Board School previous to disinfection of premises. Diphtheria caused 6 deaths, and Enteric Fever 3 deaths. Particulars of some of cases of Diphtheria. 53, Manor Street. Child 10 years, died. Drains on testing found defective, sewer gas escaping into house. 132, Wirtemberg Street. Child 10 years died in hospital. Another child was subsequently taken ill and removed to hospital. Drain proved to be defective. Typhoid or Enteric Fever. 37, Hazelrigge Road. Male 20 years. On testing drains, a leakage was discovered at foot of soil-pipe; sewer-gas escaping into dining room. 21, Oldridge Road. Male. Drains and soil-pipe defective on testing. 10, Heath Road. Two cases; mother and daughter; one month between each case. The main drain of this and three adjoining houses passed under this house, and on testing was found to be in a most defective condition. 65 Inquests. Twenty-nine inquests were held during the year, and the following verdicts returned:— 1, From Natural Cause 15 2, Accidental—Overlaying 4 Suffocation while swallowing bread 1 Run over by train 1 Injuries from fall 3 ,, ,, burn 1—10 3. Suicidal,—Cut-throat 1 Hanging 1 Drowning 1— 3 4. Open Verdict.— Found dead 1—1 Total 29 Four uncertified deaths occurred during the year, no medical evidence being taken as to the cause of death. It is obvious that in all such uncertified cases the possibility of homicide or suicide can only be eliminated by a medical examination and inquiry, and that the Coroner's judgment, founded as it must necessarily be on hearsay, should not be allowed to decide the question as to whether an inquest is required or not. Sanitary Proceedings of the Year. The number of houses inspected during the past year was 3,919, as compared with 3,441 in the previous year. The total number of nuisances dealt with amounted to 4,259, of which 3,835 were abated under notice, and 424 under promise. The table on page 22 gives a statement of the nuisances dealt with which can be conveniently tabulated. In addition to the cases stated in the table, the following works were executed:—122 new ventilating pipes inserted, 47 ventilating pipes repaired, 121 closet valve air-pipes removed from inside drinking-water cisterns, 32 soil-pipes repaired, 11 water-closets ventilated, 6 new sinks constructed, 3 66 cow-sheds limewhited, 1 cow-shed properly ventilated, 4 windows made to open, 3 leaky water mains repaired, 2 cellars drained, 2 dung pits provided, and the following miscellaneous nuisances removed:—2 dirty bakehouses, dirty filter, fish frying, leaky gas-fittings, dirty water-supply, stagnant water, privy removed, 2 cases of keeping goats in an unsanitary condition, animals kept in dwelling-houses, 2 cases of cats and dogs, 2 of rabbits, 1 of chickens and 1 donkey. 34 premises were disinfected after infectious disease, and 16 lots of bedding burnt. All the Cow-houses and Slaughter-houses were visited and their sanitary condition being satisfactory, the licenses were renewed. The Bake-houses were visited twice during the year and with the exceptions named above, were found in a satisfactory condition. The proposed It will be convenient before concluding Dust my report for 1886, to refer to the question Destructor for Clapham. of the proposed Dust Cremator, although the or ciapham. final decision (after prolonged consideration) of the Local Committee to erect such Cremator and the subsequent agitation on the part of a section of the public in opposition to it have occurred in 1887, before this report had gone through the press. An unbiassed judgment on the subject can only be obtained by a careful consideration of the difficulties attending the alternative plans for dust disposal. Each year removal of dust-refuse into the country is becoming more expensive and difficult. The increased cost has been very marked in every part of the Metropolis, and is strikingly shewn in the recent experience of Chelsea. Early in this year (1887) the Chelsea Vestry came to the end of a three years' contract for barging the dust down the river, under which the price paid was 8d. per load of 67 three cubic yards, and accepted a new contract for the same work, under which it pays 2s. 3d. per load; shewing an increase in three years of 340 per cent in the cost of removal. This increasing difficulty in the disposal of dust, and the prospect that each year the difficulty and expense would become greater (as well as the consideration that it is not the highest policy to cart away our nuisances for the poisoning of other neighbourhoods) led the Clapham Committee to investigate whether some plan for destruction of the offending materials immediately after their collection by the dust carts was not feasible. It was found that in various large towns the dust was disposed of effectually and economically by cremation, the waste heat being utilised for various collatetal operations by generating steam power. The experience of these towns was found to vary so far as the success of the cremating process was concerned. At Richmond, for instance, the furnace was constructed on a wrong principle, and the draught was so great, that even pieces of paper escaped up the chimney! In the City of London the cremator is not at present satisfactory, owing to the fact that various refuse materials are burnt in a separate small furnace, from which a hole has been opened into the main chimney. The consequence is, imperfectly burnt matter gets up the chimney and the efficiency of the Destructor is interfered with. In over 20 provincial towns Dust Cremators have been adopted, and in the cases where Fryer's Destructors have been used the result has been successful. The Clapham Committee were determined however, that no possibility of nuisance should arise, and with this object, they adopted the plan already at work in Ealing. According to this plan, the furnace in which the dust is burnt is in communication with a larger chamber furnished with cross-walls, which latter prevent 68 the current going direct into the chimney, and ensure the settlement of any dust and solid particles. Finally the products of combustion are passed through a muffle furnace, known as Jones' Fume Cremator, in which the heat is raised to l,500° Fahrenheit, and thus all incompletely oxidised solids and gases are effectually burnt. Even without this additional fume cremator the results obtained have been satisfactory, and there is every reasonable presumption that with it, a complete immunity from nuisance will be obtained. It has been urged that even supposing the combustion is complete, poisonous oxides of carbon and sulphur will be evolved; but it is forgotten that every gas-light and every fire in Clapham is producing these gases in abundance, in the latter case unfortunately with the addition of a large quantity of unburnt soot, very little above the level of the street, instead of 160 feet high (as in the proposed destructor chimney). It is not poisonous gases, the products of combustion, which from a sanitary standpoint are to be feared; these are rapidly dissipated and dispersed. It is rather the micro-organisms which find a fertile soil for their development during the putrefactive changes undergone by the animal and vegetable matters in dust-refuse, that cause sore throat, diphtheria, and other diseases. These are completely got rid of by the process of burning : and if combined with this cremation we have more frequent removal of house-refuse there is little doubt that great improvement in the health of Clapham will be secured. The opposition to the proposed Destructor originates in two quarters; the householders in the neighbourhood of the Parish Yard (the proposed site for the 69 Destructor), who have been inaccurately and imperfectly informed on the subject; and the owners of suburban villas in the neighbourhood who fear the depreciation of the value of their house-property. It is an open question whether the presence of a tall chimney will from an aesthetic standpoint depreciate the value of the houses in its neighbourhood; but the usual experience in such cases is that the existence of the supposed nuisance is after the first alarm forgotten. As the matter has now been postponed, it may be mentioned that a Destructor like that proposed for Clapham, is in process of construction at Battersea, and I believe the majority of the Members of the Clapham Committee are prepared to be guided as to the desirability of erecting a Clapham Destructor, by the result of the experience of Battersea. ARTHUR NEWSHOLME, M.D., Medical Officer of Health for Clapham. 70 PUTNEY & ROEHAMPTON. The report which I have the honour to submit for the first time as Medical Officer of Health reveals a condition of things in this Parish eminently satisfactory from a sanitary point of view. Last year's report, Dr. Walker was able to describe as the most favourable he had ever been able to present. And during 1886 I can say that the sanitary condition, as shown by the following tables, quite maintains the very high standard then obtained. Population. For statistical pnrposes, the population of Putney and Roehampton in the middle of 1886 may be put down at 15,210 This is arrived at by calculating the increase at the same rate as during the former decade. Births and Birth-rate. The birth-rale has shown a slight tendency to rise as compared with 1885, but is still very low compared with that of London generally. During the year 350 births were registered in this sub-district— 176 boys and 174 girls. This is equivalent to an average of 23.01 per 1,000. Deaths and Death-rate. The number of deaths registered during the year 1886 was 179, making an average of 11.8 per 1,000. This average shows a slight increase on that of the previous year. This increase as shown on table I. is more than accounted for by the increased number of deaths registered under Zymotic diseases. Almost half the number of deaths under this class is due to Whooping Cough, generally accompanied with bronchitic or pneumonic complication. Whooping Cough raged rather severely for some months in the sub-district and naturally we find the vast majority of its victims were very young children under the age of 5 years. 71 TABLE I. Birth and Death Rates. YEARS. Births. Birth-rate. Deaths from all Causes. Death-rate. Rate of Natural Increase. 1877 351 3l.l 170 15.0 16.0 1878 338 29.1 186 16.0 13.1 1879 327 27.4 179 15.0 12.2 1880 347 27.3 177 13.6 13.2 1881 340 25.5 167 12.5 12.9 1882 361 26.3 208 15.1 11.1 1883 349 24.7 24 17.1 7.6 1884 377 25.3 199 13.7 11.6 1885 322 21.7 167 11.2 10.4 1886 352 23.1 179 11.8 11.2 In regard to the other Zymotic diseases, we have every reason to be satisfied. Those diseases which we have more directly under our control by attention to the sanitary condition of dwelling houses—such as Diphtheria and Enteric Fever, were much less prevalent than during the previous year. They may be said to have practically died out. Only 2 deaths were registered as due to these diseases as opposed to 8 during 1885. The other classes of disease bear very much the same proportion to each other as before. The diseases of the tubercular and respiratory systems still claim their large share of victims. It appears to me the statistics given in Table II. reveal a condition of public health, on which the sanitary authorities have every reason to congratulate themselves. For the last three years the death-rate in this locality has shown a most marked and continued decrease. To my mind this is directly traceable to the sanitary precautions observed and sanitary measures regularly and systematically carried out. During the same period with this markedly diminished death-rate there has been a great increase in the density of the population with its attendant disadvantages from a sanitary point of view. Increased density of population taken by itself has, invariably an injurious influence on the public health. 72 TABLE II. PUTNEY and ROEHAMPTON. Total Deaths from each Class of Disease. 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. At 40 and under 60 years. At 60 and under 80 years. 80 years and upwards. Nobility and Gentry. Professional, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, &c. Industrial & Labouring Classes. Population (Census) 1881 13,221 Official Population in middle of 1886 15,210. Acres 2,176 CAUSES OF DEATH. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. I. Zymotic. Measles 4 2 2 1 3 .. .. .. .. .. .. .. 1 .. 3 Scarlatina 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Diphtheria 1 .. 1 .. .. 1 .. .. .. .. .. .. 1 .. .. Typhoid & Typhus Fever 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. Remittent & other Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Diseases 2 .. 2 .. .. .. .. 2 .. .. .. .. .. 1 1 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. W hooping Cough 18 7 11 4 13 1 .. .. .. .. .. .. .. 2 16 Erysipelas 1 .. 1 1 .. .. .. .. .. .. .. .. 1 .. .. Diarrhœa 9 2 7 9 .. .. .. .. .. .. .. .. 2 3 4 Dysentery & Cholera 1 1 .. 1 .. .. .. .. .. .. .. .. .. .. 1 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 38 14 24 16 17 2 .. 3 .. .. .. .. 5 6 7 II. Constitutional. Gout & Rheumatism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cancer & other Tumours 2 .. 2 .. .. .. .. .. 1 1 .. .. .. .. 2 Tubercular 19 10 9 10 2 •• .. 5 2 .. .. .. 1 1 17 Nervous 29 16 13 14 2 1 1 1 2 7 1 .. 4 6 19 III. Local. Circulatory 18 10 8 2 1 .. .. 3 3 7 2 .. 5 5 8 Respiratory 35 17 18 7 6 .. 2 3 4 11 2 .. 10 3 22 Digestive 10 7 3 1 1 1 .. .. 3 4 .. .. 2 5 3 Urinary 8 3 5 .. .. .. .. 1 3 3 1 .. 3 3 2 Generative 4 .. 4 .. .. .. .. 1 1 2 .. .. 2 .. 2 Locomotory .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. IV. Developmental. Premature Birth: Atrophy 7 5 2 7 .. .. .. .. .. .. .. .. 1 1 5 Old Age 6 3 3 .. .. .. .. .. .. 2 4 .. 2 2 2 Cause Unknown 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 V.Violence 2 2 .. .. .. 1 .. 1 .. .. .. .. .. .. 2 Total 79 87 92 52 32 5 3 18 18 41 10 .. 36 37 106 73 Table I. shows at a glance our relative birth and death rate during the last 10 years, and in Table II. are enumerated all the deaths registered in the sub-district, and classified according to the nature of the disease. From the retrospect given in Table III. the death-rate from Zymotic diseases is seen to be greater during 1886 than during either of the two preceding years. There is some ground for satisfaction however in knowing that the higher death-rate is not due to diseases traceable to neglect of the sanitary condition of houses. The great number of deaths from Whooping Cough occurring among children of infantile age is the prominent feature in the table. TABLE III. Zymotic Mortality. 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 Small-pox .. 1 .. .. .. .. .. 1 .. .. Measles 2 7 .. .. 6 13 2 1 4 4 Scarlet Fever 6 .. 3 1 8 4 7 .. .. 1 Enteric Fever 4 1 2 4 1 4 2 10 3 1 Diphtheria 1 l .. .. 1 29 24 .. 5 1 Whooping-cough .. 4 8 9 3 8 2 8 1 18 Epidemic Diarihæa 7 10 7 10 3 5 5 8 4 9 Other Zymotic Diseases 2 12 7 1 5 6 2 .. 1 4 Total Deaths from Zymotic Diseases 22 36 27 25 27 69 44 28 18 38 Zymotic Death-rate 1.8 2.9 2.1 1.3 2.0 5.0 3.1 1.9 1.2 2.49 Death-rate for all Diseases 15.0 16.0 15.0 13.6 12.5 15.1 17.1 13.7 11.2 11.8 Constitutional and other diseases. Under this table (Table IV.) there is nothing very unusual to remark upon. The tubercular and respiratory diseases maintain their usual prominence. 74 TABLE IV. Years. 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 c Gout & Rheumatism .. 3 1 4 4 4 5 5 1 .. Cancer & Tumours .. 7 3 6 1 6 8 5 8 2 Tubercular 26 32 23 18 17 12 21 24 25 19 Nervous 29 28 34 33 21 33 34 39 26 29 L Circulatory 8 12 13 13 14 12 14 11 17 18 Respiratory 29 37 42 27 24 29 30 31 29 35 Digestive 12 10 9 13 17 15 15 12 13 10 Urinary 11 2 4 6 2 6 6 10 6 8 Generative 2 .. 1 . . 2 2 4 1 1 4 Locomotory 2 .. .. .. .. .. .. .. .. .. Integumentary 1 .. 2 1 1 1 .. 2 1 .. D Premature Birth, Atrophy, &c. 8 7 8 16 18 7 17 13 9 7 Old Age 8 7 5 9 6 5 10 7 7 6 V—Violence 9 5 7 6 13 7 15 11 4 2 (Other diseases) 3 .. .. .. .. .. .. .. 2 1 Totals 148 150 152 152 140 139 196 171 149 141 Ages of the deceased. The year 1886 has been somewhat remarkable for the large number of deaths occurring among very young children. No less than 84 deaths occurred out of a total of 179 in children under 5 years of age—making the very high percentage of about 47. The diseases which have proved so disastrous to infant life have been Whooping Cough, Diarrhoea, Tubercular disease and Convulsions. Social Position. About 60 per cent of the fatal cases occurred among that part of the population included under the industrial and labouring classes. This percentage, which is larger than that of 1885, again brings out very forcibly the much greater danger which the working classes incur—partly from density of population and its attendant disadvantages, and partly also no doubt from the want of regard to the most ordinary sanitary 75 precautions. As one might expect, the mortality arising from Zymotic diseases has fallen on the poorer classes to a large extent. Out of the 18 deaths from Whooping Cough, 16 occurred among the labouring classes. Another striking feature under this heading is the large proportion of deaths from Tubercular diseases occurring among the poorer classes. Out of a total of 19 deaths 17 fell amongst this class. This goes far again to prove the pernicious influence of bad air and bad nourishment on the health of the community. Inquests. Seven inquests have been held during the year. Of these the causes of death according to the verdicts were:— I. Natural Causes, 2. II. Accidental, 3—Drowning, 2; Hydrophobia, 1. III. Suicidal, 1. IV. Found Dead, 1. The number of inquests have been fewer than usual during the year. One of these inquests which resulted in a verdict of 'Hydrophobia but cause unknown' created considerable interest. It occurred in the case of a woman rather past the term of middle life. She was ill for three or four days and died with all the symptoms of hydrophobia, which the post mortem examination so far as it went confirmed. The source of infection was very obscure. She had a small dog which she was in the habit of kissing and fondling in various ways. She had an abrasion on the inner side of the lip, and it was considered possible the poison may have been thus communicated. The old dog which died soon afterwards was in a wretched state of health at the time—thick riscid saliva constantly dribbled from its mouth. The difficulty was however, that it did not possess any of the characteristic symptoms of rabies, and the question arose 76 whether Hydrophobia could be communicated to man by the saliva of a dog in a bad condition but showing no characteristic symptoms of rabies. Deaths in Public Thirteen deaths occurred in various public institutions, institutions of persons claiming to belong to this Parish. There have been absolutely no cases of Zymotic disease amongst this class. (See Table V.) TABLE V Deaths at Outlying Institutions. DISEASE. Total. Sex. A(1B. Institutions. Male. Female. Under 1. 1 to 60. 60 and upwards. Union Infirmary. General & Special Hospitals. Asylumns Board Hospitals. Small.pox .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. Whooping.cough .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases .. .. .. .. .. .. .. .. .. Tubercular Diseases 1 .. 1 .. 1 .. .. 1 .. Cancer 2 1 l .. 2 .. 1 1 .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 3 2 l .. 2 1 1 .. .. Circulatory Diseases 4 2 2 .. 1 3 2 2 .. Nervous Diseases 3 .. .. .. .. 3 2 1 .. Other Diseases 5 4 1 .. 2 1 4 1 .. Violence 1 1 .. .. 1 .. .. 1 .. Totals 19 10 9 2 9 8 10 9 .. Sanitary The sanitary proceedings (Table XIV. Proceedings. page 22) commenced some time ago, have been continued, and there is reason to think with very great good to the community. All the sub.district has been regularly inspected by a house.to.house visitation. 77 The condition of drains has been tested, water.supply looked after, cisterns kept in good condition. The sanitary inspection is now looked upon as a matter of course by the public, and the inspector is (now) often welcomed to houses where formerly he was regarded as a legal intruder and nuisance. In almost every case defects have been remedied after the first notice. In only six cases were second notices required. No cases had to be investigated by the Magistrate, nor had any compulsory orders to be obtained. There is still much to be done in regard to the removal of dust. In too many cases the dust.bin has been allowed to remain until it has become a veritable nuisance. This however may be easily prevented by going round the parish systematically and removing the refuse from a certain district on a certain day. This plan would avoid the accumulation of the dust.bin from four to six weeks which has occurred to my knowledge in several cases. This is really an important matter, affecting in a vital way the health of the community. WM. Y. ORR, M.B., Aledical Officer of Health for Putney & Roehampton. 78 STEEATHAM, INCLUDING BALHAM AND TOOTING. I am enabled to give a favourable report on the health of this sub.district during the year 1886, though it declined somewhat from the exceptionally high standard attained in the previous year. The death.rate rose to 15.0 per 1,000 in consequence of the increased rate of mortality that resulted from Measles, Whooping Cough and Diarrhœa. On the other hand there was a marked decline in the mortality arising from other diseases in the infectious class. No death took place from either Small Pox or Scarlet Fever, only 2 from Typhoid Fever and 6 from Diphtheria. 79 The decline in the prevalence of and the mortality from the latter diseases clearly indicates a good sanitary condition of the sub.district and affords satisfactory evidence that the care and vigilance of those entrusted with the carrying out of sanitary measures are fully maintained. The following statistics derived as usual from an analysis of the Registrar General's Returns and from the local records of Sickness, Mortality and Sanitary Operations, will, I believe, corroborate these observations and disclose in detail the state of the public health in Streatham and Tooting during the year 1886. Vital Statistics. Population. It is impossible to estimate exactly the population of a growing suburb like this without the aid of an annual census and yet it is essential if we are to obtain a correct knowledge of its vital statistics. The official method of calculation assumes that the population has increased during the year under review in the same ratio as obtained in the ten years before the last census. It is very obvious that this mode of computation must yield an under.estimate of the population in this sub.district, seeing that it does not take into account the results of immigration. That our population has increased beyond the official estimate may be fairly inferred from a study of the births and birth.rate for the last four or five years, and from the number of new houses that have become occupied since 1881. However, as the official estimate is the one generally adopted, it 80 may not be departed from here. In accordance with this method of calculation the population of Streatham and Tooting in the middle of the year 1886 was 31,400. Births and The number of births registered during Birth.rate. the year was 1,078, a large increase on the decennial average; 568 were of males and 510 of females. The birth.rate calculated from the total number of births and the foregoing estimate of the population was 34'3 per 1,000 persons living during the year as compared with 35'6 per 1,000 in 1885. Natural The rate of natural increase is represented increase. excess of births over deaths; there was an excess this year of 605, giving a ratio of 19.2 per 1,000 of the population. Deaths and The total number of deaths registered Death.rate. during the year was 473, an increase of 50 on the number registered in 1885. Of these deaths 246 were of males, and 227 of females. The death.rate calculated from the whole of the deaths registered, and the official estimate of the population was 15.0 per 1,000 persons living during the year, though this rate is slightly above the decennial average, it is by no means a high one, and if we were to calculate the death. rate of the true population it would be seen to be still lower. I learn from the Vestry Clerk that there are 5,737 occupied houses in Streatham alone; calculating six persons per house, this would give us a population of 34,422, adding for Tooting 5,000, we have as the total population of the sub.district 39,422. Not to overstate 81 the case we will take the total population as being in round numbers 38 000, the death.rate calculated from this estimate of the population would be 12.4 per 1,000 persons living during the year The death.rate for the whole of London was 19.9 per 1,000 in 1886, and the death.rate in the twenty.eight great towns of England and Wales was in the proportion of 20.9 in a year per 1,000 persons living. TABLE I. Births and Death Rates. YEARS. Births. Birth.rate. Deaths from all Causes. Death.rate. Rate of Natural Increase. 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 1886 1,078 343 473 15.0 19.2 Deaths in The deaths already tabulated as occurring Outlying this sub.district do not include the deaths institutions. of persons belonging to Streatham and Tooting who died in various outlying general and special hospitals. These additional deaths are exhibited in the following table, which shows the nature of the cause of death, the age and sex of the deceased, and the character of the Institution in which they died. 82 TABLE III. Deaths in Ouflying Ivstitutions. 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 .. .. .. .. .. .. .. .. .. Scarlet Feyer .. .. .. .. .. .. .. .. .. Diphtheria .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. Whooping.Cough .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases 2 1 1 .. 2 .. .. 2 .. Tubercular Diseases 3 2 1 .. 1 2 .. 2 .. Cancer 3 2 1 .. 2 1 .. .. .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 11 8 3 .. 5 6 8 3 .. Circulatory Diseases 8 4 4 .. 7 1 3 5 .. Nervous Diseases 5 3 2 .. 3 2 2 3 .. Other Diseases 15 8 7 3 8 5 7 8 .. Violence 1 1 •• .. •• .. .. 1 .. Totals 48 29 19 3 28 17 22 26 •• It will be seen that 48 deaths occurred in Outlying Institutions, of these 29 were of males, and 19 of females, 22 took place in the Union Infirmary, 26 in general and special Hospitals, and none in the Hospitals set apart for infectious diseases. If these 48 deaths are added to those actually occuring in the sub.district, the death.rate would be raised 1.5 per 1,000, giving an inclusive rate of 16.5 per 1,000 of the population. This inclusive rate must not be compared with the death.rate of former years, because the deaths of persons in Outlying Institutions have only recently been included in the local rate. I think it ought to be noted that some of these outlying deaths are only nominally of parishioners, whilst others are of persons so long resident in the institution in which they died, as to have lost their claim to be considered parishioners, and lastly there are the deaths of new comers and temporary residents to set off against the total outlying deaths. 83 STATISTICS OF MORTALITY. STREATHAM, including TOOTING & BALHAM. Population (Census) 1881 25,553 Official population 31,400 in middle of 1886 Total deaths fiom 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 GO years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks,&c Industrial and Laboring Classes. CAUSES OF DEATH. I. Zymotic. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. 3 8 2 9 .. .. .. .. .. .. .. 2 1 8 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Typhus Frver .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 3 .. 3 .. .. .. 2 1 .. .. .. .. .. 1 2 Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 6 5 1 2 1 3 .. .. .. .. .. 1 2 1 2 Whooping. Cough 26 12 14 12 13 1 .. .. .. .. .. .. 3 12 11 Erysipelas 1 1 .. .. .. .. .. .. .. 1 .. .. .. 1 .. Diarrhoea, Dysentery, and Cholera 20 11 9 17 3 .. .. .. .. .. .. .. 3 8 9 'Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 67 35 32 33 26 4 2 1 .. 1 .. 1 10 24 32 II. Constitutional. Gout and Rheumatism.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cancer & other Tumours 17 5 12 .. .. .. .. .. 6 11 .. 2 4 6 5 Other Constitutional Diseases 1 1 1 1 .. .. .. .. .. .. .. .. .. .. 1 Tubercular Phthisis 26 13 13 1 1 1 2 9 12 .. .. 1 5 14 6 Tabes Mesa 4 2 2 3 .. .. 1 .. .. .. .. .. 1 3 .. Hydrocephalus 8 4 4 4 2 2 .. .. .. .. .. .. 1 2 5 Scrofula 2 •• 2 .. .. .. .. 1 1 .. .. .. .. 2 .. III. Local. Nervous 79 37 42 28 9 1 .. 5 6 24 6 9 12 35 23 Circulatory 40 21 19 .. .. .. 3 5 14 17 1 1 7 17 15 Respiratory 96 55 41 17 17 2 2 8 10 30 10 7 14 25 59 Digestive 40 19 21 12 .. 2 .. 4 9 10 3 5 6 12 17 Urinary 16 11 5 .. .. 1 .. 2 6 7 .. 5 1 5 5 Generative 4 .. 4 .. .. .. .. 4 .. .. .. .. 1 2 1 Locomotory 2 1 1 .. 2 .. .. .. .. .. .. .. .. .. 2 Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. IV. Developmental. Premature Birth & Low Vitality 40 26 14 40 .. .. .. .. .. .. .. .. 4 9 27 Congenital Defects 3 1 2 1 .. 2 .. .. .. .. .. .. 1 1 1 Old Age 21 9 12 .. .. .. .. .. .. 10 11 4 6 4 7 V. Violence 6 5 1 4 1 .. .. .. 1 .. .. .. .. 1 5 VI. Illdefined and Not Specified Illdefined 1 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 473 246 227 144 58 15 10 40 65 110 31 35 73 163 202 84 ' Zymotic Diseases There were 67 deaths in this class, 35 their were of males and 32 of females; they yield Prevalence a per Centage of 14.1 upon the deaths from Fatality. all causes during the year, and give a death. rate of 2.1 per 1,000 of the estimated population, this is double the extremely low zymotic death.rate of 1885, but it is below the rate recorded in several years of the decennium as may be seen in Table IV. The increased death.rate from infectious diseases is due to the mortality arising from Measles, Whooping Cough, and Diarrhœa. The subjoined Table contrasts all the deaths resulting from the several principal epidemic diseases, with the death.rate therefrom, as well as the death.rate from all diseases during the last ten years. TABLE IV. Zymotic Mortalityin the Streatham & Tooting Sub.district. 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 Small.pox 4 1 .. .. .. .. .. .. .. .. Measles 2 11 2 1 3 5 7 8 2 11 Scarlet Fever 1 2 5 31 13 9 2 8 .. .. Diphtheria 3 3 2 7 1 4 13 3 5 6 Enteric Fever 5 1 3 5 2 1 8 4 6 3 Whooping.Cough Epidemic 6 11 21 8 9 9 11 9 7 26 Diarrhœa Other Zymotic 4 13 3 6 9 3 9 11 12 20 Diseases 4 .. 10 10 9 10 15 11 2 1 Total deaths from Zy motic Diseases 29 42 41 68 44 41 65 53 34 67 Zymotic Death. rate 17 2.3 2.2 2.7 1.7 1.6 2.3 1.8 1.1 2.1 Death .rate from all Diseases.. 125 16.7 15.0 13.9 12.1 12.6 14.9 15.3 13.9 15. 0 On referring to the Table it will be seen that there was 110 death from Small Pox, nor did any case die in 85 Hospital coming from this sub.district; there has been in fact complete immunity from this disease: whereas in 1885 twenty cases of Small Pox were sent into hospital, where two died. No death arose from Scarlet Fever, and there has been a marked decline in its prevalence and intensity during the two last years, in neither year has there been any fatal case and only eight cases were sent into Hospital in 1886. There can be little doubt that our present immunity from Small Pox and the decline in the prevalence and intensity of Scarlet Fever is in a large measure due to the more complete system of isolation now adopted and to the early removal of these infectious cases to special Hospitals, as well as to the systematic and thorough fumigation, disinfection and cleansing of infected houses, clothes and bedding, after the removal of patients to Hospital, or after recovery from the disease at home. The mortality from Diphtheria considered in relation to the increase of population was below the average, and Typhoid Fever was very markedly so; only two deaths were ascribed to this latter disease and one to simple continued fever, and no death from Typhoid took place in Hospital. It may be inferred from the low rate of mortality from these diseases that they werfc not prevalent during the year. The decline therefore in their prevalence and mortality is an indication of the improved sanitary condition of the sub.district, in relation more especially to house drainage, the syphoning off of foul gases, the supervision and cleansing of cisterns and the abatement generally of nuisances. As regards the Mortality from some other diseases in the zymotic class, I cannot report so favourably. 86 Measles to wit caused eleven deaths, and was prevalent throughout the year. This disease is regarded very lightly amongst the industrial classes, it is treated at home without medical aid and without any effort at isolation, the children on recovery at once mix with others, and so the disease spreads indefinitely. The only check to its dissemination is in the case of children attending school; such children absent from school through illness, are not permitted to return unless they bring with them a medical certificate of their freedom from infection; but unfortunately this rule is, I believe, too often evaded. Whooping Cough again was very prevalent if we take the 26 deaths as the measure of its extent. The mortality from this disease exceeded that of any year of the decennium. Diarrhoea was prevalent during the hot weather, it caused 20 deaths chiefly of sickly and hand.fed children. other Diseases. These are grouped under five heads in the Mortality Table, viz :—Constitutional, Local, Developmental, Violence and Ill.defined. All the deaths from the diseases included under these various headings slightly exceeded the number recorded in 1885, without "correction for increase of population. Separately considered, the number of deaths from some of the diseases differ considerably from that of the previous year. The deaths from consumption were only 26 as against 43 in 1885, forming only 5.4 per cent of all deaths. 87 Respiratory diseases were not so fatal as in 1885, the deaths from these diseases formed 20.2 per cent of all deaths as against 24 per cent last year. Diseases of the nervous system resulted in 79 deaths, giving a per centage of 14.5 upon all deaths. There were forty deaths from Diseases of the Circulation as compared with 26 in the previous year, forming 8.4 per cent of all causes of death. The mortality from the other diseases under the various headings do not differ sufficiently from their averages to call for special remark. Age at Death— It will be gathered from what has gone infant Mortality, before that there was a higher ratio of deaths of infants under one year of age than in 1885, 144 children died in the first year of life, being 30.4 per cent of all deaths, 42.7 per cent of all deaths took place before the age of five, and 47.5 before twenty years of age. The mortality from Tubercular and Respiratory diseases in early life fell below that of the previous year, whereas the deaths from Measles, Whooping Cough, and Diarrhoea rose considerably. The infantile death.rate was 133 per 1,000 births as compared with 110 last year. Semie Mortality. There are only 21 deaths ascribed solely to old age, though no less than 141 deaths took place at 88 and over sixty. The ages of 42 of those ranged from 70 to 80, and 30 from 80 to 90, several of these being nearly 90. Senile deaths yield a per centage of 31.2 on all deaths as compared with 25.5 per cent in 1885. Of the persons who died at 70 and upwards, 33 were of males and 39 females. The number of persons who were under Sickness and Mortality reatment, together with the nature and extent amongst the out.door of the sickness that prevailed, and the deaths Parish Poor, that took place amongst the out door parish poor will be found in Table XIII. page 2 ; 218 new cases came under treatment throughout the year, 34 of these were in the Zymotic class, they include 8 cases of Scarlet Fever, 16 of Measles, 8 of Diarrhoea, 1 of Fever, and 1 of Erysipelas; none of these were fatal. The cases of Scarlet Fever were sent into Hospital, there were 5 deaths in the other classes. The ratio of deaths to cases treated was 2.2 per cent. The following Table shows the per Social Position. centage of deaths in the various classes during the year. Nobility and Gentry 35= 7.4 per cent. Professional Class, Merchants, &c.73 = 15.4 ,, Middle and Trading Class 163 = 34.5 „ Industrial and Labouring Class 202 = 42. 7 „ Total deaths in 1886 473 100.0 There was a higher Mortality in the Professional and Mercantile Class as well as in the Trading and Middle Class, and a decrease of Mortality amongst, the Industrial Classes. 89 inquests. Seventeen inquests were held with the Violent Deaths.following results:— I. Natura Convulsions 1 Spasm of the Glottis 2 Syncope 6 Eupture of Aneurism 1—10 II. Accidental .. Suffocation in bed 4 Injury to head from fall 1 Accidental scalds 1—6 III. Homicide .. Neglect at birth 1—1 17 Uncertified Eleven deaths were uncertified, they Deaths. were all submitted to the Coroner before being registered as having probably died from the following causes:— Premature Birth 1 Bronchitis 1 Haemorrhage 1 Rheumatism of the heart 1 Spinal affection 1 Syncope 1 Convulsions 2 Morbus Cordis 1 Senile Paralysis.1 Atrophy 1 11 Sanitary A summary of the principal Sanitary Proceedings, operations of the year will be found in Table XIV. page 22. From this it will be seen that a very large amount of Sanitary work has been done, 3,680 houses and premises were inspected and their sanitary condition recorded ; 329 first notices were served to remedy the several defects discovered on inspection, only 9 second notices were required to ensure compliance. It was not found necessary in any case to appeal to a Magistrate, 90 Amongst the more important operations of the year may be mentioned the lifting and relaying of imperfect drains, and the cleansing of foul drains and the syphoning off of sewer gases, altering sinks, baths, lavatories, and rain.water pipes to discharge over gullies outside, cleansing and repairing of water.closets, causing water to be laid on to closets, and providing cisterns, dust.bins, &c. The figures in respect of these sanitary improvements are shown in the Table. In addition to this 15 pig nuisances were removed, and 52 accumulations of manure got rid of; 23 dilapidated and unwholesome houses were cleansed and repaired, and 15 unclassified nuisances were removed. The number of complaints of the non.removal of dust and house refuse, have greatly diminished since the adoption of a system for the regular and orderly clearing of the dust.bins of certain districts on certain days under the direction of an Inspector appointed for the purpose. Only 23 houses were disinfected after infectious diseases as compared with 32 last year. It is satisfactory to be able to report that there has been no occurence of disease after disinfection. There are 33 bake.houses in the sub.district, they are all now regularly inspected and are in good condition. The cow.sheds and slaughter.houses have been regularly inspected. 1 personally visited each one and saw no reason to oppose a renewal of the owners' licenses. F. F. SUTTON, M.D., Medical Officer of Helath for Streatham & Tooting. 91 WANDSWORTH. The mortality of the past year has been considerably higher than that of its predecessor; the excess however, will be found to have resulted from a proportionally greater increase in the population than has hitherto obtained. The increase in the number of deaths occurred generally from all classes of disease, but Whooping.Cough, Measles and Diarrhoea, which were the prevailing epidemics, were attended with more than usual fatality; the deaths from the last named disease, which prevailed almost wholly in the summer months, were exclusively confined to infants. It is worthy of special note that Small.pox was entirely absent throughout the year. The following statistics are submitted in evidence of the foregoing conditions, with the other usual details of the health and sanitary state of the Sub.district. Vital Statistics, Population. The mean number of inhabitants during the year 1886, amounted to 32,320, if according to the official method of calculation the same 92 rate of increase that prevailed during the last intercensus decennium then continued. It may be confidently assumed however, that this estimate is an understatement to a very great extent, the effect of which, would be to unduly raise both the death.rate and birth.rate if determined from that datum. The correctness of such assumption will bccome apparent on a consideration of the following circumstances. 1. The extraordinary large increase in the number of births. 2. The great increase in the number of inhabited houses. 3. The proportion of births to population in the preceding decennium compared with the like proportion in the past year. Each of these points requires separate examination. Births, Birth.rate, Rate of Natural Increase.—The births registered during the year numbered 1255,—657 of males and 598 of females, or 133 more than in 1885. The average number during the preceding ten years, allowing for increase of population during that period, was 1022. The births therefore of the past year exceeded the average by 233 or 22.7 per cent. Such an amount is much too great to be attributable to anv other cause than immigration. No. of inhabited From an examination of the parochial houses, Rate.Book it appears that the number of inhabited houses during the past year was 5676. The Census of 1861 gave 7.05 persons to each house, the Census of 1871, 6.67 persons, and that of 1881 6.58 persons to each house. If the moderate computation of six persons be allowed to each house, a population of 34,056 is arrived at which is probably much below the real number. 93 Determined by the proportion which the Proportion of Births to mean number of births bore to the mean Population Population during the ten preceding years, the mean population of 1886 Would he 33,983, and the birth.rate 36.97 per 1,000. The two foregoing estimates taken in conjunction with the unusually great increase in the number of births, and the circumstance that the birth.rate for all London was the lowest on record since 1850, furnish strong presumptive evidence of the existence during the past year of a much larger population than that determined by the official mode of calculation which gives a birthrate of 4040 per 1,000, and a rate of natural.increase— (the excess of births over deaths) of 21.35 per 1,000. Mortality. The total deaths registered during the year numbered 722,—379 of males and 343 of females. The annual average number during the ten preceding years, allowing for increase of population, was 597. The deaths in the past year therefore exceeded the average by 125, or 20 per cent. No less than 144 of the total deaths occurred in public institutions, viz :—in the County Lunatic Asylum, 112; in the Hospital for Incurables, 11; in St. Peter's Hospital, 4; in the Prison, 14; and in the Workhouse, 3. In addition to the foregoing deaths that were registered within the sub.district, 78 deaths of Wandsworth parishioners took place in the following outlying institutions, viz:—in the Union Infirmary, 58; and 20 in various Metropolitan Hospitals; these with the sex, age, and cause of death are shewn in the following table:— 94 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 .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. Diptheeria .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. Diarrhœa .. .. .. .. .. .. .. .. .. Other Zymotic Diseases. .. .. .. .. .. .. .. .. .. Total Zymotc Diseases .. .. .. .. .. .. .. .. .. Tubercular Diseases 12 4 8 2 9 1 11 1 .. Cancer 3 .. 3 .. 2 1 2 1 .. Rheumatism 1 .. 1 .. 1 .. 1 .. .. Respiratory Diseases 10 5 5 .. 2 8 9 1 .. Circulatory Diseases 9 7 2 .. 4 6 9 .. .. Nervous Diseases 13 7 6 1 4 8 8 5 .. Other Diseases 26 11 15 1 9 16 1/ 9 .. Violence 4 3 1 .. 3 1 1 3 .. Total 78 37 41 4 34 40 58 20 .. Death.rate. Calculated from the deaths registered and the official estimate of the population, the death.rate of the past year was 22.33 per 1,000 persons living. But, as has been explained in previous reports, determined in this manner it cannot be accepted as representing the natural death.rate of this sub.district, inasmnch as the death.register embraces the whole mortality of the County Lunatic Asylum, St. Peter's Hospital, and the Hospital for Incurables, the inmates of which institutions are, with a fractional exception, derived from without the Parish, undergo no natural increase, and are subject to a very high mortality; the latter constituting on an average about one fifth of all deaths registered. It is found necessary therefore to eliminate from the calculation, the population, and 95 mortality of these institutions, and to add to it the. deaths of Wandsworth parishioners that occurred in the Union Infirmary. Calculated in accordance with these conditions the death.rate of the past year was 19.05 per 1,000. This rate is at least 1 per 1,000 higher than that deducihle from the number of occupied houses, or from the average proportion of births to population already referred to. Inclusive of the deaths that occurred in institutions external to the sub.district, and which are probably fully compensated by the deaths of non. parishioners. the rate would be 21.1 per 1,000. The latter, therefore, cannot be accepted as correct, for while the deaths of the parishioners dying without the parish are accurately recorded, there is no means of ascertaining the number of deaths that occur within the parish of persons who belong to other districts, and which ought to be excluded. The Birth and Death rates for the past and ten preceding years are shewu in the subjoined table. 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 23.80 1877 684 29.90 384 12.59 1613 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 1617 16.71 15.90 1884 1,072 36.72 576 17.23 18.77 18.84 1885 1,122 37.37 628 18.82 19.93 18.55 1886 1,255 4040 722 1905 22.33 21.35 * Deaths in Outlying Institutions not included. Causes of In the following table all the causes of Death. death will be found classified according to the sex, age at death, and the social position of the deceased persons, the diseases of the zymotic class being severally set forth:— 96 STATISTICS OF MORTALITY. WANDSWORTH. Population (Census) 1881 28,00 Official Population in middle of 1885 31,497 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 a ge. | 80 years and upwards. Nobility and Gentry. Professional class Merchants, Bankers, &e. Middle and Trading- Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. CAUSES OF DEATH. I. Zymotic. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 28 21 7 9 18 1 .. .. .. .. .. .. .. 3 25 Scarlet Fever 6 3 3 .. 5 .. .. 1 .. .. .. .. .. .. 6 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 8 3 5 .. .. .. 1 4 1 .. .. .. .. 3 5 Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 10 6 4 2 4 2 .. 1 .. 1 .. .. 3 1 6 Whooping Cough 31 16 15 15 16 .. .. .. .. .. .. .. 1 8 22 Erysipelas 4 3 1 .. .. .. .. .. 3 .. .. 1 .. 2 1 Diarrhœa, Dysentery, and Cholera 28 15 13 26 2 .. .. .. .. .. .. .. 1 6 21 Other Zymotic Diseases 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 Totals of Zymotic Class 116 67 49 54 45 5 1 6 4 1 .. 1 5 23 87 ii. Constitutional. Gout, and Rheumatism 6 3 3 .. .. .. .. 1 1 4 .. .. .. 2 4 Cancer & other Tumours Other Constitutional 21 9 12 .. .. 2 .. 1 1 11 .. 3 1 8 9 Diseases 3 2 1 1 .. .. .. .. 1 1 .. .. .. 1 2 Tubercular Phthisis 54 24 30 8 7 .. 9 21 16 .. .. 3 3 17 31 Tabes Mesenterica 24 15 9 17 6 .. .. 1 .. .. .. .. .. 4 20 Hydrocephalus 8 5 3 2 5 1 .. .. .. .. .. .. .. 3 5 Scrofula 1 1 .. 1 .. .. .. .. .. .. .. .. .. .. 1 III. Local. Nervous 151 82 69 34 11 1 1 29 45 29 1 2 8 50 91 Circulatory 46 16 30 1 2 1 1 4 16 20 1 1 4 18 23 Respiratory 135 70 65 31 41 5 1 8 17 26 6 3 1 32 99 Digestive 30 17 13 11 .. 2 1 4 9 3 .. 3 3 7 17 Urinary 26 17 9 .. .. .. 1 3 10 10 2 1 .. 15 10 Generative 4 .. 4 .. .. .. .. 3 .. 1 .. .. .. 2 2 Locomotory .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. IV. Developmental. Premature Birth and Low Vitality 37 23 14 37 .. .. .. .. .. .. .. .. 3 8 26 Congenital Defects 8 5 3 7 1 .. .. .. .. .. .. .. 1 3 4 Old Age 32 7 25 .. .. .. .. .. .. 12 20 3 1 14 14 V. Violence 17 14 3 2 2 .. 1 3 6 3 .. .. .. 1 16 VI. Ill-defined and Not specified Ill-defined. 2 2, .. .. .. .. .. 1 1 .. .. .. .. .. 2 Not specified 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 Totals 722 379 343 207 120 17 9 85 133 121 30 20 30 208 464 97 As might he anticipated from the circumstance of the death-register containing the whole mortality of the County Lunatic Asylum, diseases of the Brain and Nervous System formed the largest number of deaths, amounting to no Jess than 151 or nearly 21 per cent, of the whole, 112 of the number having occurred in the Asylum. Withdrawing this class from consideration, for the reasons explained in reference to the death-rate, the following are the proportions borne by the several classes of disease in the causation of mortality. As in the previous year, diseases of the Respiratory Organs shewed a considerable numerical excess forming upwards of 18 per cent of all deaths and thus displacing from their accustomed position Zymotic diseases which contributed 16 per cent. Tubercular diseases formed 12 per cent, considerably more than three-fourths of which were furnished by Consumption; Other Constitutional diseases which were formerly grouped under the heading of Cancer, Dropsy, and Diseases of Uncertain Seat, 41 per cent; forming a total of the Constitutional Class slightly in excess of the Zymotic Diseases of the organs of Circulation caused 6.3 per cent; Premature Birth, Malformation, &c., nearly the same amount; Old Age, 4.4 per cent to which diseases of the Digestive Organs closely approximated; Urinary Organs, 3.6 per cent; and Violence, 2.3 per cent. With the exception of diseases of the Digestive Organs, which were 3 less than the average, and those of the Integument and the Organs of Locomotion which shew a minute diminution, all deaths from Diseases of the Non-zymotic Classes were in excess of their respective decennial averages; some greatly so, as those from diseases of the Respiratory Organs which exceeded the average by 39 per cent., from Constitutional diseases over 18 per cent., from diseases of the Circulation, 58 per cent., and from Premature birth, &c., 40 per 98 cent. The numerical variation of the deaths from all causes in the past year compared with their corresponding numbers in the preceding ten years and with their respective averages are exhibited in the two following tables, the first comprising the mortality of the Nonzymotic, and the second that of the Zymotic class of diseases:— Ron-zymotic Mortality.—Table shewing the number of Deaths in 11 years 1876—86, with the increase or decrease of deaths in 1886, compared with the annual average deaths in 1876—85 raised in proportion to increase of population. Causes of Death. 1876. 1877. 1878. 1879. 1880. 1881. 1882. 1883. 1884. 1885. 1886. 1886. No. above corrected average. No. below corrected average. Constitutional. Tubercular 61 54 60 62 60 61 69 64 85 90 87 9 .. Other Constitutional 18 17 14 12 17 19 19 20 18 28 30 9 .. Local. Nervous 125 111 111 96 168 121 106 116 128 145 151 14 .. Circulatory 26 21 19 20 23 28 28 25 22 36 46 17 .. Respiratory 58 42 86 125 89 90 87 69 70 101 135 38 .. Digestive 29 18 29 21 21 28 28 35 47 22 30 .. 3 Uriuary 6 9 4 10 11 4 20 13 15 12 26 15 .. Generative 2 3 4 10 1 .. 4 . . 3 6 4 1 .. Locomotory .. .. 1 .. 3 2 1 .. 2 2 .. .. 1 Integumentary .. .. .. .. .. .. 1 •• .. 3 •• .. 4 Developement Premature Birth 22 19 18 18 27 37 27 23 40 37 45 13 .. Malformation Low Vitality Age 16 13 14 26 23 27 27 33 42 34 32 2 •• Violence 14 11 13 11 11 20 18 32 21 15 17 . . 3 Ill-defined or 1 3 1 1 •• 4 1 .. .. .. 3 2 •• Not specified 99 Zymotic Mortality. The following table exhibits the total Epidemic Diseases, their prevalence deaths that occurred from Zymotic disand fatality. eases, particularizing those that resulted from the seven principal Epidemic Diseases during the past and ten preceding years, and the relative proportion which they bore to the deaths from all causes. It also shews the increase or decrease of deaths in 1886 compared with the annual average deaths in 1876 85, raised in proportion to increase of population:— Diseases. 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 1886. No. above corrected average. No. below corrected average Seven principal Epidemic Diseases. Small Pox 1 .. .. 1 .. 9 .. .. 1 3 .. .. 1.7 Measles Scarlet 17 •• 4 16 9 5 18 14 6 19 28 15 •• Fever 12 21 2 15 24 19 9 5 5 3 6 .. 7 Diphtheria 1 .. 4 1 4 1 3 11 4 6 10 6 .. Fever Typhusi 12 9 3 8 6 4 9 12 4 4 8 •• .. Enteric Whooping Cough 10 11 6 44 15 12 26 5 17 24 31 11 .. Diarrhœa 16 16 19 7 20 19 29 10 27 35 28 5 .. Cholera 2 .. .. .. .. .. .. .. .. .. .. .. .. Total Deaths from above Epidemic Diseases 71 57 38 92 78 69 94 57 64 94 111 27 .. Other Zymotic Diseases 9 6 10 12 14 7 14 20 19 3 5 .. 8 Total Deaths from ZymoticDiseases 80 63 48 104 92 76 108 77 83 97 116 1.9 .. Zymotic Deathrate per 1,000 3.45 2.64 1.96 4.14 3.35 2. 71 3.72 2.57 2.70 3.07 3.58 57 .. Total Deaths fron all causes 461 384 422 16 184 507 544 499 576 528 722 125 .. Per centage ol Deaths from Epi demies to Deaths from all causes 15.4 14.8 9.0 17.8 16.1 13.6 17. 2 11.4 11.1 14.9 15.3 12 .. 100 On reference to the table it is seen that the total deaths that occurred from the above diseases amounted to 116, 111 of which were of the epidemic kind. The latter exceeded the average number by 27 or 32 per cent. The cxccss was due to Whooping-Cough, Measles, Diarrhoea and Diphtheria. Whooping-Cough was the most extensively prevalent and fatal of these diseases, having caused 31 deaths, or 11 above the average ; it prevailed for the most part during the first seven months of the year. During the same period Measles was also unusually prevalent, causing 28 deaths, or more than double the average. Diarrhoea was very prevalent in the hot season, and resulted in 28 deaths, or 5 more than the average. The deaths were exclusively confined to infants, and with two exceptions wholly under one year of age. Diphtheria caused 10 deaths, or 6 above the average. Scarlet Fever, as in the Metropolis generally, declined in amount, producing 6 deaths only, or 7 below the average. The deaths from Fever were 8 in number— the average amount. Small-pox was entirely absent from the sub-district, not a single case having occurred during the year. Vaccination.—The record of Vaccination, as contained in the Return made by the Vaccination Officer to the Local Government Board, may be here satisfactorily considered. Respecting the vaccination of children whose births occurred in 1885, it appears from such Return that of 1,121 children born, 951 were successfully vaccinated, 1 was returned as "insusceptible," 91 died unvaccinated, 15 were postponed on account of sickness, and 4 removed to places duly recorded, leaving 59 or 5.2 per cent, who had removed to places unknown or which could not be reached. Recurring to infectious diseases, eight cases only of 101 the kind, viz:—4 Enteric Fever, and 4 Scarlatina were sent into the Metropolitan Asylum Board Hospitals during the year, and all recovered. The smallness of the number sent into hospital was due to the circumstance that the prevalent diseases were those for which hospital accommodation is not, but ought to be, provided. The following table shews the months in which the deaths from epidemic diseases occurred and the mean temperature of each quarter of the year. By far the greater majority of the deaths is seen to have occurred, as in the previous year, in the first and third quarters; the bulk of those in the latter was due to Diarrhoea, and was attributable, as pointed out by the Registrar-General in his annual summary, to the hot weather that prevailed through the summer months. DISEASE. January February March April May June July August September October November December Mean Temp. Mean Temp. Mean Temp. Mean Temp. 36.5 52.5 61.2 44.6 Small Pox .. .. .. .. .. .. .. .. .. .. .. .. Measles 4 9 10 3 .. .. 2 .. .. .. .. .. Scarlatina .. .. 1 1 .. .. 1 1 .. .. 2 .. Diphtheria .. .. 1 1 1 1 .. .. 1 .. 3 2 Whooping Cough 4 5 6 3 7 4 .. ..1 .. 1 .. Diarrhœa1 .. .. .. .. .. 14 3 5 .. .. .. Fever .. .. .. .. .. .. .. 3 2 1 2 .. Totals 9 14 18 8 8 5 17 12 9 1 8 2 41 21 38 11 Deaths in relation to Social Position. The following table exhibits the proportion per cent, of deaths from zymotic diseases as well as of the total deaths in relation to the social position of the deceased:- 102 Social Position. Total Deaths. Deaths from Zymotic Diseases. 1886. Decennial Average. 1886. Decennial Average. Nobility and Gentry 2.77 3.50 0. 86 1.33 Professional Class, Merchants, Bankers, &c. 4.16 4.96 4.31 4.61 Middle & Trading Classes, Clerks, &c. 28.81 21.35 19.83 19.61 Industrial and Labouring Classes 64.26 70.19 75.00 74.45 100.00 100.00 100.00 100.00 The figures of last year, compared with those of the year preceding, shew a very considerable reduction in the relative amount of mortality suffered by the labouring classes, both as regards the total amount as well as that portion which occurred from zymotic disease, viz:— to the extent of 294 percent, of the former and 2.32 per cent, of the latter. The latter result was scarcely to be anticipated in presence of a higher general mortality than usual from those diseases which afflict the labouring classes with greatest severity. Infant Mortality. The death rate of infants in the past year was unusually high, the result of a correspondingly greater prevalence of the zymotic diseases most obnoxious to infant life. All the deaths from WhoopingCough and Measles occurred to children under 5 years of age, and those from Diarrhoea almost exclusively to infants under 1 year of age. The deaths of infants under one year formed 48.6 per cent, of all deaths, the average being 26.7; of children under 5 years, 45.2 per cent., the average being 42.8 per cent., whereas all deaths under 20 years of age formed 48.8 per cent., the average being 50.6 per cent. The proportion of deaths under 1 year 103 to the number of births was 16.4per cent., the decennial average being 15.5 per cent. Senile Mortality, of the total deaths, 32 were registered as having resulted from old age per se, but 84 or 11.6 per cent, occurred at the age of 70 years and upwards, the highest age attained (that of a female), being 99 years. In the following summary of the number, sex, and age of the deceased, the deaths of females are seen to form considerably more than twice the number of those of males. Age. Males. Females. Total. 70 — 75 10 16 26 75 — 80 9 21 30 80 — 85 1 9 10 85 — 90 4 11 15 93 .. 1 1 96 1 .. 1 99 . . 1 1 25 59 84 As the attainment of high ages in relation to the total deaths in a locality may be accepted in some measure as an exponent of the latter's salubrity, it should be observed that the number of persons attaining the age of 80 years and upwards in this sub-district considerably exceeds that of the whole Metropolis. Sickness and Mortality amongst the Parochial Poor. The nature, amount and fatality of disease that occurred amongst the parochial poor during the year are exhibited in Table III. in the Appendix. It is there seen that the total number of fresh cases of disease that came under treatment was 104 696, 25 of which ended fatally, or slightly over 3½ per cent. There were 129 cases of infectious disease resulting in 6 deaths; 8 of the total viz:—4 of Enteric Fever, and 4 of the 5 cases of Scarlet Fever that occurred were moved to hospital and there recovered. There were 23 cases of "Whooping-Cough with 3 deaths, 44 cases Measles with 2 deaths, and 44 of Diarrhoea with 1 death. The low relative proportion of deaths to cases treated both of general and infectious diseases indicates a comparatively slight intensity of the diseases that then prevailed. It is somewhat remarkable that although there was a considerable increase in the number of deaths from Diphtheria throughout the sub-district, there was not a single case of that disease amongst the parochial poor; in possible connection with this circumstance also there were but 5 cases of Scarlet Fever amongst them, four of which, as already stated, were removed to hospital. Inquests. Violent Deaths. Uncertified Deaths. The number of inquests held during the year was 44, or 9 more than in 1885, with verdicts of death from natural causes returned in 26 instances, and from violence in 18 or 1 more than in the year preceding. The number of uncertified deaths has greatly diminished of late years; there were 17 in the year 1884, 8 in 1885, and during the past year there were 7 only, and these it appears were referred to the Coroner who considered medical inquiry unnecessary. As any of these cases may have resulted from other than natural causes, it would afford a greater sense of security to society if a preliminary medical investigation, in place of a non-professional inquiry, were made in every case in which the cause of death is not certified by a registered Medical Practitioner (see report for 1865 and following). The number and sex of the persons who formed the 105 subjects of inquests, with the verdicts of the latter, are shewn in the following tabulated form:— Males. Females. Total. Deaths from natural causes 19 7 26 Deaths from violence, viz :— Accidental Concussion of Brain from a Fall .. — .. 1 Scalds and Burns — .. 2 Drowning .. 3 — Fractures . . 2 .. — Suffocation . . 3 .. — Thrown from a Cart .. 1 . . — Other Injuries . . 1 .. — 13 Suicidal Pistol Shot 2 .. — 2 Homicidal. Manslaughter-.. 11 Found Dead — .. 1 1 Not specified Found Drowned 1 .. .. .. 1 32 12 44 Sanitation. The number and nature of the ordinary sanitary operations carried out during the year will be found set forth in Table XIV., page 22, as far as they can be so tabulated, for it is obvious that a vast amount of work of the kind cannot be demonstrated in that manner. They will be found to have kept pace with the Sanitary requirements of the Sub-district,", and to have been wholly carried out without the necessity for an intervention of the law, a circumstance that speaks favourably of the tact and discrimination employed by the sanitary Inspectors who have performed their important duties in a highly satisfactory manner. All the Bake-houses in the Sub-district, 38 in number, were as usual periodically inspected; and the Cow- 106 houses 18, with the Slanghter-houses 8 in number, were examined and reported on as to their condition previous to the renewal of their owners' licenses. They were all found in a satisfactory state. As regards the latter structures, however, a great sanitary improvement would be effected if the various private slaughter-houses were superseded by a public "Abattoir" for the entire District, or for South London. Especial attention was paid to the disinfection and purification of houses after the presence of infective diseases. Sulphur-fumigation done thoroughly, having been, as hitherto, the agent employed in every instance of the kind ; and experience continues to prove the complete trustworthiness of the process, for on reference to the Table it is seen that in 192 houses so disinfected there was not a single instance of a recurrence of disease; no stronger evidence could be adduced in its favour. Amongst the many other important details contained in the Table relating to drainage, water supply, and the removal of nuisances, (some of which formed the subjects of special reports), one that deserves particular attention is that relating to the inspection of houses. No less than 4,105 houses and premises underwent careful examination during the year, and in 525 instances defects were found and remedied. This searching and systematic house-inspection, which is one of the greatest benefits conferred on the inhabitants by the powers vested in the Board, cannot be too sedulously pursued, and might be extended, so as to admit of more frequent supervision, with much advantage to the public health. By its means sanitary defects, more or less dangerous to health and life, are discovered, which, without such investigation, would remain unnoticed or 107 unheeded. It is a source of satisfaction to note that by its operation the houses of all classes, but especially of the working classes, have been rendered better adapted for the maintenance of health and the prevention of disease, that occupiers have acquired a better knowledge of what is right and wrong in the structural arrangements relating to the sanitary requirements of their houses; and that as a consequence, the visit of the inspector, instead of as formerly being resented as an intrusion, is now welcomed and often invited as a benefaction. GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsworth. 108 ANALYST'S REPORT, To the Wandsworth Board of Works. Gentlemen, It having become customary for me to annually supplement the dry figures of my official quarterly reports by a few remarks on the state of the food supply of the district, and on the working of the sale of Food and Drugs Act therein, I beg this year to be permitted to refer briefly to one or two points upon which it is desirable that those members of the public who take an interest in their local affairs, should have a clear understanding before they proceed to criticise the action of their representatives. I have found that persons who speak generally upon food without such understanding, usually repeat one of two hackneyed complaints, and I therefore propose to take these seriatim, and to show some of the difficulties which beset the present state of the law:— (1), It is said "our local officers favor the publicans, because they never find bad beer, while the Excise officers do continually," This is simply because the law has placed the excise chemist in a position enabling him to detect the addition of sugar and water to beer, which is denied to the public analyst. An exciseman has the power of entry into a publican's cellars and can take what samples he pleases. He therefore takes a sample from the cask under draught, and at the same time, he takes one from an untouched eask of the same delivery, In this way he supplies his analyst with specimens of the beerasitcomes in and as it goes out, and then avery simple research enables the chemist to say whether or not water or sugar has been added. The local Inspector of food has no such power; he can only buy over the counter and, there being no legal definition of the word "beer" nor any standards of strength for such articles, it follows that all a public aualyst can do is simply to see that the beverage is 109 some, but whether it has been watered or not he cannot legally say. We therefore see that, were the food Inspector placed in the same position as the Exciseman, then the local officers and Boards would appear to the public to be quite as clever and active as they now seem helpless and supine in the matter of beer. (2). It is said:—"there is a lot of poor milk about which the Inspector never finds, and miserable stuff often passes public analysts as genuine." Here again we are indebted for such criticism to causes arising out of the state of the law. The cause of the first portion of the complaint lies in a decision of the High Court of Justice that milk in transitu from a vendor to the house of his customer in pursuance of a contract for a daily supply paid weekly, is not legally on sale to the public. The Inspector cannot therefore demand a sample, and even the person receiving the milk cannot take proceedings because he cannot comply with the needful formalities. Until Inspectors are vested with additional powers, people who engage in weekly contracts with their milkman thereby (unless they make a special written contract legally framed for the supply of milk of a definite purity), forfeit all protection from the public Inspectors. This is a point that should be more generally known, and it is a fact that the milk so delivered at houses is not, as a rule, so good as that sold over the counter. On the second head of complaint, the state of the law has also operated to tie the hands of the analyst. If a vendor who is charged with diluting his milk feels himself wronged, the law enables him, very properly, to appeal against the decision of the public analyst. This appeal is made to the Excise chemists at Somerset House, who, as public servants having no local interests, are presumably the best persons for such a purpose. Unfortunately this theoretically excellent law has become a potent factor in causing the supply of slightly diluted milk. All natural milk contains water, and the amount is variable according to food, season, &c. In judging of the purity of milk, the reference chemists have chosen for their standard that of the poorest possible natural milk, and public analysts are therefore driven to follow suit and pass all milk as legally genuine which exceeds this very low limit. If a public analyst chose to stand up against this standard, his decisions as to quantities of added water of about ten per cent, or under would be continually reversed on appeal, and his Board and the public 110 would both cease to have any confidence in his abilities. It pays a dairy farmer or large dealer much better to secure rich, milk by proper feeding and breeding, and then to reduce it to the standard! than to deal with poor milk. When therefore the Board's officers catch a man it is generally where the retailer has been doing a little extra work on his own account upon a milk already "standardised" down to Somerset House Strength before it comes into his hands. The result is that we get a regular dead level of milk as defined by the reference chemists, but do not, as formerly, get one day good rich milk when the supply is copious and real half-and-half when it is short. The remedy to this will be in the passing of a law making it necessary that all milk should be sold at a fair average standard fixed by Act of Parliament, and that poor bred cows which do not give a proper article should be discarded. In conclusion, I have to report that the food supply of the district fully maintains its excellent quality. This is no doubt due to the care with which the Board carries out its excellent system of daily inspection by an officer specially appointed for the purpose. Such regular inspection is much better than sudden raids, and although we may not in Wandsworth figure in the eyes of the public every now and then with large batches of prosecutions alternated with periods of inactivity, I feel satisfied that in no other district is the Act better carried out. I believe that the regular action of the Board is universally more respected by the tradesmen, and that we have now very few in the district who do not honestly comply with the Act by selling mixed articles as such and not as pure. The very difficulty that the Inspector experiences in purchasing impure articles without such declaration (which then makes their sale legal in the present state of the law) is a proof of the success of the system originated and carried out since the first passing of the Act by the Wandsworth Board. I have the honour to be, Gentlemen, Your obedient Servant, JOHN MUTER, Ph.D., f.r.s. Ed., f.i.c. Public Analyst.