WAN 38 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 1887. By The MEDICAL OFFICERS OF HEALTH. TO WHICH IS APPENDED THE REPORT OF THE ANALYST, London: ASHFIELD, STEAM PRINTER, BRIDGE ROAD WEST, BATTERSEA. 1888. To the Board of Works for the Wandsworth District. Gentlemen, We have the honour to present our Report for the year 1887, on the vital statistics and sanitary condition of the Wandsworth District. The details given in the Introductory and the various Local Reports shew that a higher standard of health is being gradually attained, while the Sanitary work of the District is being carried out on an increasingly large scale and with greater efficiency and completeness. As this is the last year in which Battersea will form an integral part of the District, the following table is given, as shewing very strikingly the enormous increase in the rateable value and population of this District since the year 1856 (when the Metropolis Local Management Act came into operation), and at the same time the decrease in mortality, especially from zymotic diseases, which are most immediately under the control of sanitary measures. Rateable Value. Population. Death-rate from all Diseases. Zymotic Death-rate 1856. 1887. 1856. 1887. 1856. 1887. 1856. 1887. Battersea £79,100 £661,196 12,530 142,763 25.5 17.1 3.59 3.45 Clapham 82,500 256,486 18,200 43,045 15.7 13.9 2.14 2.3 Putney 35,000 137,463 5,800 15,690 16.4 12.5 2.33 0.44 Streatham & Tooting 68,519 315,396 9,700 38,226 11.5 1 1.7 1.54 2.2 Wandsworth 43,900 227,657 10,871 33,141 21.3 1 7.3 4.04 1.4 Whole District £299,019 £ 1,598,197 56,881 272,764 19.7 15.7 2.74 2.72 It has been laid down by Dr. Farr as a general law that assuming the local conditions remain the same, an increase in density of population is accompanied pari passu by an inncerased mortality. We have to congratulate you however, on the fact that as the density of the population in this District has increased, its mortality has steadily diminished. This may be ascribed in part to the complete system of drainage now universally adopted, to the purer drinking water, and to the generally improved conditions under which people now live as compared with 21 years ago. Much remains to be done, and at the present time, we are especially anxious to witness the adoption of some system of Compulsory Notification of Infectious Diseases in this District, which we have reason to believe will enable us to cope more successfully with epidemics, and in many instances to stifle them in their birth. We have the honour to remain, Gentlemen, Your obedient Servants, The Associated Medical Officers of Health of the Wandsworth District. REPORT, ON THE HEALTH AND SANITARY CONDITION OF THE ENTIRE DISTRICT. 1887. VITAL STATISTICS. Population. The official population of the Wandsworth District at the middle of the year 1887, was 272,764, being an increase of 15,022 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 in nearly all the sub-districts, the true population is considerably higher than the estimated population. Births. The total births registered during the year numbered 9,194—4,667 of males and 4,527 of females. The number of births and the birth-rates in the several sub-districts are compared in the following table:— 6 TABLE I. BIRTHS. RATES. Sub-Districts. Males. Females. Total. Birthrate. Rate of Natural Increase. Battersea East 1278 1210 2488 34.2 19.0 West 1398 1310 2698 38.4 17.9 Clapham 539 597 1136 26.3 12.4 Putney 156 193 349 22.3 9.8 Streatham 623 562 1185 31.1 19.3 Wandsworth 673 665 1338 41.9 24.5 Whole District 4667 4527 9194 33.7 17.9 The birth-rate per thousand persons living was 33.7 as compared with 34.5 in the previous year. The birthrate for the whole of London during the same period was 31.7 per 1,000. The natural increase of the population, or excess of births over deaths was 4,902, and the rate of natural increase 17.9 per 1,000. Deaths. The total deaths registered during the year numbered 4,302,—2,120 of males and 2,182 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-Districts. Males. Females. Total. Battersea East 506 510 1016 14.0 West 712 723 1435 16.5* Clapham 293 307 600 13.9 Putney 97 99 196 12.5 Streatham 217 228 445 11.6 Wandsworth 295 315 610 15.5* Whole District 2120 2182 4302 15.77 * Excluding the deaths in institutions. 7 The death-rale for the whole district was 15.77 per 1,000 persons, which is considerably lower than that recorded in any previous report. The following table shows this fact more accurately:— TABLE III. Birth-rates, Death-rates, and rates of Natural Increase in the entire district during the ten years 1877—86, compared with those of the year 1887. Years. Births. Birth-rate per 1000. Deaths. Death-rate per 1000. Natural Increase. Rate of Natural Increase per 1000. 1877 6159 38.6 2991 18.7 3168 20.0 1878 6508 39.4 3275 19.8 3233 19.8 1879 6833 39.7 3526 20.5 3307 19.2 1880 7038 34.2 3593 17.5 3445 16.8 1881 7582 35.6 3647 17.1 3935 18.5 1882 7889 35.6 3851 17.4 4038 18.2 1883 8079 35.1 4083 17.7 3996 17.3 1884 8979 37.5 4266 17.8 4713 19.7 1885 8606 34.6 4192 16.8 4414 17.9 1886 8896 34.6 4398 17.0 4489 17.4 Mean of Ten Years 1876—85 7646 36.4 3732 18.0 3873 18.4 1887. 9194 33.7 4292 15.7 4902 17.9 It will be seen from this table that the death-rate is 0.5 per 1,000 less than the decennial average. It is also 5.1 per 1,000 less than the rate for the 23 great towns of England and Wales, and 2.8 per 1,000 less than that for the whole of the Metropolis. 8 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-rate in District per 1,000 of the Population. During 10 years, 1851-60 20.40 „ „ 1861-70 19.34 „ „ 1871-80 18.06 During the year 1881 17.16 „ „ 1882 17.42 „ „ 1883 17.49 „ „ 1884 17.85 „ „ 1885 16.87 „ „ 1886 17.06 „ „ 1887 15.77 Deaths in Outlying institutions, The deaths already enumerated do not include those of inhabitants of this District who have died in various hospitals and other institutions outside the District. To a great 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, vagrants in lodging houses, &c., 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 Institutions 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 39 15 14 2 .. 3 5 .. 1 38 Diphtheria 7 3 3 1 .. .. .. 2 5 .. Enteric Fever 6 1 3 1 .. .. 1 .. 4 2 Whooping Cough 5 2 .. 3 .. .. .. 5 .. .. Measles .. .. .. .. .. .. .. .. .. .. Other Zymotic Diseases 12 4 3 1 3 1 2 9 1 Tubercular Diseases 90 31 15 20 1 8 15 42 42 6 Cancer 35 15 9 6 .. 4 1 8 27 .. Rheumatism 2 1 .. .. .. 1 .. 1 1 .. Respiratory Diseases 59 13 10 14 8 6 8 33 23 3 Circulatory Diseases 49 20 3 10 3 6 7 30 19 .. Nervous Diseases 69 21 8 18 9 8 5 32 25 12 Other Diseases 109 35 22 13 4 11 24 40 66 3 Violence 44 21 10 5 1 5 2 4 40 Total 526 182 100 93 27 55 69 199 262 65 Corresponding Totals in preceding year 462 178 63 76 19 48 78 197 250 15 It will be seen that 526 deaths occurred in outlying institutions, of which 199 were in the Union Infirmary 262 in the general and special hospitals of the metropolis and 65 in the Asylums Hoard Hospitals. In this tabu the deaths of West Battersea inhabitants occurring in the Union Infirmary (68 in number), are not included. As the total deaths occurring in the Union Infirmary (268 10 in number) have been already included in the 4,302 deaths occurring within the district, there remain 327 to add in order to obtain the complete mortality of this District. This gives a death-rate of 16.97 per 1,000 as compared with 18.09 in the previous year. Use of Outlying Institutions by each Sub-district. The number of deaths in outlying institutions enables us to form an approximate idea of the relative use of such institutions by each sub-district. Thus for every 1,000 of the population there died in outlying institutions including the Union Infirmary :— 1886. 1887. For East Battersea 2.5 2.4 per 1,000 ,, West Battersea 2.4 1.8 „ „ Clapham 18 1.7 „ „ Putney 1.9 1.2 „ ,, Streatham 1.5 1.2 „ „ Wandsworth 2.4 2.0 „ 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 proportionate mortality among the industrial classes. In table VI. the deaths occurring in the entire District during 1887, 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 1887. 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 1,000 excluding deaths in Public Institutions, within and without the Subdistrict. Death-rate per 1,000 including deaths in Outlying Institutions, excluding deaths and inmates in Public Institutions within the Sub-district. Industrial Classes. Other Classes. East Battersea 72,550 26.6 76 86.8 13.2 14.0 16.6 West Battersea 70,213 25.7 50 86.3 13.7 16.5 18.9 Clapham 43,045 15.7 34 57.0 43.0 13.9 16.5 Putney 15,590 5.7 7 60.7 39.3 12.5 14.3 Streatham 38,225 14.0 11 39.6 60.4 11.6 13.0 Wandsworth 33,141 12.3 13 66.4 36.6 15.3 17.5 12 TABLE VI. Summary of Deaths and their Causes, registered in the entire District during 1887, classified according to Sex, Age, and Social Position, and showing also the relative numbers in each Sub-district. POPULATION of entire District, (Census) 1881, 272,764, Official Population in middle of 1887, 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 East Battersea—Population, 72,550. Area in acres, 947. West Battersea—Population, 70,213. Area in acres, 1,396 Clapham—Population. 43,045. Area in acres, 1,233. Putney—Population, 15,590. Area in acres. 2,176. Streatham. Tooting and Balham—Population 38,225. Area in acres. 3.465. Wandsworth—Population, 33,141. Area in acres, 2,478. 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 OF DEATH 1. Zymotic. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 147 33 46 25 2 21 20 81 66 39 93 13 1 1 ... ... ... ... 4 17 126 Scarlet Fever 60 18 30 6 1 4 1 33 27 2 35 14 6 2 1 ... ... ... 2 6 52 Typhus Fever 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Enteric Fever 29 3 14 4 ... 1 6 13 16 ... 1 6 4 9 7 2 ... ... 42 6 21 Puerperal Fever 18 7 9 ... ... ... 2 .. 18 ... ... ... 2 16 ... ... ... ... ... 4 14 Diphtheria 43 8 15 10 1 7 2 17 26 4 20 14 5 ... ... ... ... 2 3 5 33 Whooping Cough 153 58 54 25 2 6 8 58 95 59 87 7 ... ... ... ... ... ... 6 14 133 Erysipelas 30 7 12 6 1 3 1 9 21 8 1 ... 1 5 5 6 4 2 4 5 19 Diarrhœa, Dysentery, & Cholera Other Zymotic 245 99 76 24 ... 16 30 125 120 185 37 3 1 1 5 12 1 2 6 30 207 Diseases 18 13 ... ... ... 4 1 12 6 6 5 3 ... 3 ... 1 ... ... 2 3 13 Totals of Zymotic Class 744 246 256 100 7 64 71 348 396 303 278 60 20 38 18 21 5 6 31 90 619 II. Constitutional. Gout, and Rheumatism 44 2 16 9 ... 6 11 22 22 ... ... 5 3 13 9 12 1 3 6 13 22 Cancer and other Tumours 125 14 33 30 11 21 16 40 85 ... ... 1 1 8 53 58 4 12 17 32 64 Other Constitutional Diseases 44 5 21 7 ... 6 5 19 25 18 ... 1 1 7 6 10 ... 4 4 7 29 Tubercular Phthisis 379 75 126 43 20 36 79 205 174 5 11 4 40 163 123 33 .. 2 31 74 272 Tabes Mesa 181 73 53 12 2 11 30 93 88 131 34 5 6 7 4 .. .. 3 2 12 164 Hydrocephalus 54 14 15 13 1 10 1 34 20 18 28 4 3 1 ... ... ... ... 4 8 42 Scrofula 21 ... 11 7 1 1 1 12 9 11 3 1 2 1 3 ... ... ... 1 6 14 III. Local. Nervous 572 121 159 81 36 60 115 307 265 155 82 18 13 39 105 138 22 25 45 103 399 Circulatory 270 37 91 52 23 35 32 128 142 6 3 4 4 39 94 107 13 19 26 45 180 Respiratory 852 226 302 110 34 76 110 396 456 195 215 34 11 50 114 193 40 20 45 131 656 Digestive 205 20 66 46 20 23 30 94 111 57 6 4 9 28 43 51 7 9 23 43 130 Urinary 105 17 36 14 8 13 17 67 38 ... 7 2 4 19 36 32 5 5 14 28 58 Generative 23 5 14 2 ... ... 2 1 22 ... 17 5 1 ... 2 5 16 Locomotory 25 1 23 ... ... ... 1 13 12 3 6 1 4 2 3 6 ... 1 1 ... 23 Integumentary 7 ... 6 1 ... ... ... 5 2 1 1 ... 1 1 2 1 ... ... ... 1 6 IV. Developmental. Prematu re Birth, Low Vitality and Congenital Defects 346 102 100 46 14 46 38 193 153 337 2 ... ... ... ... ... 2 22 46 276 Old Age 185 21 67 18 12 31 36 69 116 ... ... ... ... ... 1 94 90 24 16 41 104 V. Violence 102 37 26 9 7 10 13 65 37 31 12 6 7 19 20 7 ... 1 3 22 76 VI. Illdefined & not specified 18 ... 14 ... ... 2 2 9 9 6 3 ... 1 3 4 1 ... ... ... 2 16 Totals 4302 1016 1435 600 196 445 610 2120 2182 1277 698 152 130 455 638 765 187 136 291 709 3166 13 Infantile Mortality. The deaths of children under one year of age amounted to 29.7 per cent of the total number of deaths. The true infantile mortality expressed by the proportion of deaths under one year to births is shewn in the following statement:— Deaths under 1 year per 1,000 births— In East Battersea 162 „ West „ 151 „ Clapham 122 ,, Putney 151 „ Streatham 101 ,, Wandsworth 114 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 1880—86 is compared with that of last year. TABLE VII Social Status. 1880 1881 1882 1883 1884 1885 1886 1887 Nobility & Gentry 3.40 2.71 3.43 2.48 4.41 2.76 2.79 3.16 Professional Class 5.50 5.12 4.44 5.66 6.25 4.67 75 6.78 Middle Class 16.91 19.00 20.85 19.59 25.66 19.10 18.94 16.43 Industrial Class 74.20 73.17 71.28 72.37 63.68 73.47 71.52 73.63 100.0 100.00 100.00 100.00 100.00 100.00 100.0 100.00 Causes of Mortality. The relative number of deaths from the various diseases, are stated in Table VI. zymotic diseases being given in greater detail. In the following table, a comparison is made with the corresponding deaths of the ten previous years. 14 TABLE VIII. Showing the total number of deaths and their causes registered in the entire District, during the eleven years 1877-87, with the relative numbers of each class of disease. DISEASES, And other causes of Death 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 1887 Class: 1 Zymotic Small Pox 57 19 4 3 37 1 .. 9 5 .. .. Measles. 64 84 125 59 134 115 133 182 140 124 147 Scarlatina 58 39 134 173 100 119 65 47 11 21 60 Diphtheria 7 19 17 19 18 51 63 43 29 32 43 Whooping Cough 73 149 148 123 105 163 133 145 178 213 153 Typhus and other fevers 64 39 62 44 37 49 52 58 41 39 32 Diarrhœa & Choleraic Disease 114 182 94 213 149 117 158 239 193 230 245 Erysipelas 13 5 13 10 15 18 10 28 17 24 30 Metria, Childbirth 20 7 28 23 29 19 25 24 23 13 18 Carbuncle .. .. .. .. .. 3 .. .. .. .. .. Influenza 1 .. .. .. .. .. .. .. .. .. .. Quinsy .. 1 .. 1 .. 1 .. .. .. .. .. Croup 20 39 40 19 18 31 60 38 .. .. .. Other Zymotic Diseases .. .. .. .. .. .. .. .. 1 5 18 Totals of Zymotic Class 491 583 665 687 642 687 699 817 638 701 744 2. Gout and Rheumatism 13 15 8 15 25 25 25 24 32 28 44 3. Cancer & other Tumors 101 106 91 110 118 144 114 148 105 117 125 4. Other Constitutional Diseases .. .. .. .. .. .. .. .. 23 26 44 5. Tubercular Diseases 514 501 513 625 557 521 654 715 664 662 655 6. Nervous 450 503 474 464 540 539 574 602 594 627 572 7. Circulatory 204 212 203 193 245 251 255 269 278 298 270 8. Respiratory 519 694 891 657 695 850 829 758 982 952 852 9. Digestive 155 150 117 155 208 195 234 227 186 215 205 10. Urinary 63 42 74 66 70 89 99 80 81 97 105 11. Generative 29 19 25 20 35 32 30 35 42 33 23 12. Locomotory .. .. .. .. .. .. .. .. 11 23 25 13. Integumentary 6 1 3 8 3 9 10 3 9 6 7 14. Premature Birth, Low Vitality, Malformation, &c. 212 177 170 266 232 234 241 304 259 299 346 15. Old Age 126 141 141 136 120 153 185 154 171 192 185 16. Violence 82 75 83 96 113 104 94 111 97 100 102 17. III Defined and Not Specified 26 56 68 95 44 18 40 19 21 22 18 Totals 2991 3275 3526 3593 3647 3851 4083 4266 4193 4398 4302 16 Zymotic diseases caused 17.2 per cent of the total deaths as compared with 15.9 per cent in the previous year. The zymotic death-rate was 2.72 per 1,000 of the population, as compared with 2.71 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 147 33 46 25 2 21 20 Scarlet Fever 60 18 30 6 1 4 1 Diphtheria 43 8 15 10 1 7 2 Enteric Fever 30 3 14 4 .. 3 6 Whooping-cough 153 58 54 25 2 6 8 Epidemic Diarrhœa 245 99 76 24 .. 16 30 Other Zymotic Diseases 66 27 21 6 1 7 4 Total Deaths from Zymotic Diseases 744 246 256 100 7 64 71 Zymotic Deathrate 2.72 3.3 3.6 2.3 0.44 1.6 1.4 Death-rate from all Diseases 15.77 14.0 13.9 12.5 11.7 17.3 If to the 744 deaths from zymotic diseases be added the 69 deaths from the same diseases in outlying institutions of inhabitants of this district (see table IV.), the zymotic death-rate becomes 2.98 per 1,000 of population, as compared with 2.84 in the previous year. 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 60 deaths at patients' own homes and 39 at the Asylums Board Hospitals; Enteric Fever, 30 deaths at home and 6 in hospital; Diphtheria, 43 deaths at home and 7 in hospital. Diarrhoea, Measles and Whooping Cough were as usual the most fatal of the zymotic Diseases, causing fivesevenths of the total mortality from these diseases. Asylums' Board The preceding figures only give the Hospitals, mortality from the various epidemic diseases. In the absence of compulsory notification of all cases of the chief epidemic diseases, the following table of patients admitted into the Asylums Board Hospitals during the past year, with the Table of Sickness and Mortality current among the parochial poor, (Table XIII.) gives the only further available indication of the number of cases of infectious disease in this district. TABLE X. Number of cases of Infectious Diseases admitted into the Metropolitan Asylums Board Hospitals during 1887. Small Pox. Scarlet Fever. Enteric Fever. Typhus Fever Battersea .. 302 32 .. Clapham .. 55 3 .. Putney .. 3 .. .. Streatham 1 27 1 .. Wandsworth .. 18 6 .. Entire Wandsworth District 1 405 42 .. Corresponding totals in 1886 4 76 34 .. 17 The number of Scarlet Fever admissions to the Asylums' Board Hospitals was 412, as compared with 76 in the previous year. The total deaths from Scarlet Fever belonging to this district was 99, as compared with 23 in the previous year. It follows therefore that either a large proportion of the cases were removed to hospital, or Scarlet Fever was of a less fatal type than in the previous year. Probably both of these suppositions are correct. In the whole of London, 1,447 deaths from Scarlet Fever occurred, which gives a lower death-rate from this disease than in any except the two immediately preceding years. The number of cases admitted into the Asylums' Board Hospitals, which had been 1,399 in 1885, and 1,789 in 1886, rose to 5,933 in 1887. Thus the deaths from Scarlet Fever were, during 1887, twice as many as during 1886 ; but the number of cases admitted was more than three times as many. In 1887, of the 1,447 deaths from Scarlet Fever in London, 500 occurred in the Asylums' Board Hospitals, and 27 in the London Fever Hospital, equal to 36.5 per cent, of the total deaths, as compared with 22.6 per cent, in the previous year. The Compulsory Notification of Infectious Diseases has formed the subject of a special report, which we have the honour to append. The time seems ripe for its adoption in the Metropolis, and we hope that next year we shall be able to state that steps have been taken in this direction. 18 COMPULSORY NOTIFICATION OF INFECTIOUS DISEASES. To the Sanitary Committee. 29th December, 1887. Gentlemen: The extreme desirability of registration of all cases of the more serious infectious diseases is now generally acknowledged, and has on various occasions been advocated by us, At present we are dependent for information chiefly on the death-returns and poor-law returns, which represent only a minority of the cases, and only reach us after sufficient time has elapsed to allow of free spread of the infection. The Voluntary notification of cases by medical practitioners on payment of a fee, which has been tried in a few places, is at best imperfect, and nothing short of compulsory notification seems fully to meet the requirements of the case. The chief advantages of compulsory notification are— (1.) The early isolation and separation of infectious cases. Perhaps no better instances of the great value of compulsory notification in this respect can be found than by a comparison of Metropolitan with Provincial mortality from Small Pox. According to Dr. Seaton the average mortality in London from Small Pox during the last 6 years, is 26 per 100,000 of the population, while in Leicester it is only about 1 in 100,000. Leicester forms a very striking example of the advantages of notification combined with an admirable sanitary organization. (2.) Early notification limits the centres of infection by enabling the sanitary officials to prevent the mixing of 'suspects' who have been exposed to infection with others; and in case of Small Pox by enabling vaccination (at Leicester) to be performed on all who have been exposed. (3.) Certain collateral advantages are secured. When cases of Diphtheria or Enteric Fever are notified, the sanitary condition of the house is examined, and the milk and water supplies are investigated. The influence of the inspector in impressing on Householders the importance and necessity of long continued isolation requires also to be mentioned. It should be clearly understood that notification is but a means to an end. Unless information of cases is followed by efficient isolation, it can do but little good. Hence the necessity for further powers enabling the Sanitary Authority to compulsorily remove the infectious patients to hospital, where there are no means of isolation at home. It would appear that bee. 26 of the Sanitary Act, 1866, does not give this power. The appended table (see end of report) represents the experience of 44 towns in which compulsory notification is in force, representing altogether more than one-eighth of the whole extra-metropolitan population. It will be seen (a) that in but one instance (Greenock) is it made compulsory on the householder only to notify the existence of infectious disease, when a practitioner is in attendance : (£) that in 9 towns (Aberdeen, Ashton-under-Lyne, Dewsbury, Edinburgh, Hartlepool, Manchester, Norwich, Preston, Rotherham) it is compulsory on the practitioner in attendance only ; though in some of these, if no practitioner is in attendance, the compulsory duty falls on the householder; (c) while in 34 towns what is known as the Dual system is adopted, the duty of notification being compulsory on both householder and practitioner. The remarks made by Medical Officers of Health for these 44 towns on the relative merits of the various systems of notification, (in answer to a special circular sent round by us, which contained the queries at the head of the appended table), are suggestive and useful; but we do not think it necessary in this stage of the discussion to recommend any one system of notification, only emphasising our unanimous opinion that the entire onus of notification shall not fall on the practitioner, but rather on the head of the household. We may add that the Local Government 19 Board is collecting imformation on the subject (especially as to the relative working of the different plans), and there seems every reason to think that with sufficient, pressure from Local Authorities, compulsory notification may at no distant date come into force in the Metropolis and render our sanitary work much more efficient and complete that it can possibly be with our present imperfect imformation. We are Gentlemen, Yours obediently, W. H. KEMPSTER. F. F. SUTTON. G. E. NICHOLAS. A. NEWSHOLME. J. OAKMAN. W. Y. ORR. Medical Officers of Health. The following table gives the Vaccinations perforated in this district during 1886. TABLE XI. SUBDISTRICTS. Number of Births Returned from 1st January to 31st December, 1886. Successfully Vaccinated. Insusceptible of Vaccination. Had Small-pox. Dead Unvaccinated. Postponed by Medical Certificate. Removed to Districts Vaccination Officer of which has been duly apprised. Removed to places unknown, or which cannot be reached; and cases not having been found. East Battersea 2526 2015 15 .. 262 52 7 174 West Battersea 2626 2104 11 .. 228 66 2 213 Clapham 1092 871 4 .. 104 28 8 73 Putney 353 289 2 .. 39 7 5 11 Streatham 1091 871 3 .. 98 36 23 56 Wandsworth 1260 1042 5 .. 120 21 2 70 Totals 8948 6192 40 .. 851 210 47 597 It will be seen that during the year, all the births were accounted for, except 6.6 per cent., who in all probability remained unvaccinated. Inquests. Deaths by Violence. The inquests held last year were 208, as compared with 221 in the; revious year, and formed 4.8 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 XII. It will be seen that of the total number, 104 were due to natural causes, and 104 to violence. Of the latter, 76 were accidental, 12 were suicidal, 9 were homicidal, and in 5, open verdicts were returned, 20 TABLE XII. Verdicts. Sub-Districts. Total. Battersea Clapham Putney Streatham Wands worth East West Deaths from Natural Causes: 104 15 30 14 1 9 36 Deaths from Violence: Accidental: •• .. .. .. •• •• •• Drowning 15 8 3 .. 2 .. 2 Suffocation 26 14 8 .. .. 1 3 Railway Injuries 5 2 1 .. .. 2 .. Scalds and Burns 5 .. 1 1 .. 1 2 Poisoning 2 .. .. 1 .. 1 .. Concussion, Fracture, &c. 10 .. 1 1 1 3 4 Injuries from Fall 7 3 4 .. .. .. .. Hydrophobia .. .. .. .. .. .. .. Other Injuries 6 3 3 .. .. .. 1 Suicidal: Poisoning 2 .. .. 1 .. .. 1 Hanging 1 .. .. 1 .. .. .. Shooting 1 .. 1 .. .. .. .. Drowning 4 .. 0 1 3 .. .. Cut-Throat 4 .. 2 2 .. .. .. Homicidal: Neglect at Birth 3 1 2 .. .. .. .. Manslaughter 6 .. .. .. .. .. .. Poisoning .. 6 .. .. .. .. .. Open Verdicts : Found Drowned 2 .. 2 .. .. .. .. Found Dead 2 .. 1 .. .. .. 1 Newly Bern 1 .. 1 .. .. .. .. Totals 208 52 60 22 7 17 50 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 52, as compared with 70 in the previous year. Of the 52, 14 occurred in East Battersea, 16 in West Battersea, 5 in Clapham, 5 in Putney, 6 in Streatham, and 6 in Wandsworth. co 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 Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Battersea East 1364 33 .. .. 19 2 54 .. 2 .. 16 2 49 4 .. .. 20 .. 7 .. .. .. 201 4 25 7 10 1 16 .. 945 13 West 671 28 .. .. 18 2 34 .. .. .. 18 2 18 .. .. .. 4 .. 7 .. .. .. 124 12 2 2 10 4 13 .. 423 6 Clapham 738 35 .. .. 31 4 10 .. .. .. 17 4 46 5 .. .. 14 1 6 .. 26 .. 165 6 16 2 3 35 3 373 10 Putney and Roehampton 86 .. .. .. 2 .. 1 .. .. .. .. .. 8 .. .. .. .. .. .. .. .. .. 19 .. 1 .. .. .. 5 .. 50 .. Streatham, including Tooting and Balham 395 19 2 .. 30 1 17 .. .. .. 10 1 20 1 .. .. 1 .. .. .. 2 .. 50 3 3 .. .. .. 2 2 260 11 Wandsworth 683 31 •• •• 15 2 2 .. 1 .. 1 .. 25 .. .. .. 5 .. 6 .. .. .. 207 10 13 2 8 5 37 1 363 11 Totals 3937 146 2 115 11 118 .. 3 .. 62 9 116 10 .. .. 44 1 26 .. 28 .. 766 3 50 13 31 10 108 6 2414 51 22 Sickness and Mortality among: Parochial 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 3,937, as compared with 3,364 in the previous year. The proportion of deaths to cases treated was 3.6 per cent., as compared with 3.1 per cent, in the previous year. Sanitary Operations of the year. A study of Table XIV. will shew the detailed 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. 23 TABLE XIV. Summary of Sanitary Operations in the entire District during the year 1887. East Battersea. West Battersea. Clapham. Putney. Streatham and Tooting. Wandsworth. Total. Number of Houses & Premises inspected 9864 8679 3531 3841 3841 4449 31205 1st Notices served 926 857 940 642 445 740 4550 2nd Notices served 203 236 121 108 17 60 625 Number of houses disinfected after infectious diseases 290 322 78 14 53 192 949 Number of houses in which infectious disease recurred after disinfection .. .. .. .. .. .. .. Number of houses from which bedding, &c., was burnt 2 3 19 .. 3 1 28 Disinfecting apparatus at Putney, number of times used .. .. .. 12 .. .. 12 Overcrowding abated 17 5 3 4 2 1 32 Rooms cleansed and repaired 65 78 212 6 82 53 496 Staircases & passages cleansed and repaired 16 20 45 .. 17 13 111 New drains and drains relaid 255 170 161 84 Number of feet of new sewers and branch drains 6256 3791 7476 Drains cleansed and repaired 332 454 229 82 158 96 1351 Syphon traps fixed to drains 244 205 474 5 272 .. 1200 Sinks altered to discharge outside over gullies 222 45 161 7 77 3 515 Bath and lavatory wastes altered to discharge outside over gullies .. 1 39 .. 23 .. 63 Rain water paper disconnected from drains 25 21 63 5 97 .. 211 Water-closets cleansed and repaired 62 43 410 276 99 86 976 Water-closets, supply of water laid on to 522 397 21 .. 86 259 1285 Urinals cleansed, repaired or water laid on 7 2 2 5 57 .. 73 Accumulation of manure, &c., removed 27 23 58 14 87 6 215 Cesspools abolished 4 1 10 31 1 47 Dust-bins provided 181 129 113 58 26 117 604 Stables drained or paved and cleansed 13 1 8 10 17 2 51 Yards drained and paved 26 25 62 23 33 11 180 Unwholesome or dilapidated houses cleansed & repaired 328 320 7 6 70 7 738 Leaky house-roofs and guttersrepaired 65 62 79 6 11 55 278 Houses supplied with water 25 22 20 23 46 23 157 Water-cisterns covered and repaired 409 249 397 65 113 180 1413 Cistern overflow pipes disconnected from drains .. .. 37 .. 57 .. 94 Wells closed .. 1 .. .. 3 .. 4 Pig nuisances removed 3 6 .. 3 13 4 29 Unclassified nuisances 9 11 261 48 73 22 424 Cases investigated by Magistrates 5 5 2 2 .. 2 16 Compulsory Orders obtained .. .. 2 .. .. 2 4 Compulsory works executed .. .. .. .. .. LOCAL SUMMARIES. 27 battersea. The official estimate of the population of the whole parish for the year 1887 was 142,763, being an increase of 5,896 persons during the twelve months. The natural increase, being the excess of births over deaths was 2,735, and at the rate of 19 per thousand for the year. The births of 2,676 males and 2,510 females, together 5,186 were registered during 1887, and the birth-rate for the year would consequently be 36.32 per thousand, that for London generally being 31.7 per thousand. The deaths were—of males, 1,218; and of females, 1,243, the total being 2,451, and the rate 17.16 per thousand. Of these, however, 132 were non parishioners who died in the Union Infirmary, and if these are deducted, the death-rate would be 16.2 per thousand. The Metropolitan death-rate was 19.6 for the year under consideration. 28 east battersea. The official mean population of the sub-district of East Battersea, calculated in accordance with the method formulated by the Registrar-General to the middle day of the year 1887, was 72,550. This calculation is on the assumption that an equal number of persons was added to the population during the year, as was found to have been the case during each of the ten years, 1871-81. The number thus added, 2,948 annually, is probably not far from the actual number, as nearly one-half, viz : 1,472 was the natural increase of the population in 1887, the births exceeding the deaths to that extent, which was at the rate of 20.28 per thousand, in 1886 the rate being 20 per thousand. The subjoined table shews the relative proportions of the birth and death-rates, with the actual natural increase of the population, for the ten years preceeding. TABLE I. Birth and Death Bates. YEARS. Births. Birth-rate. Deaths from all Causes. Death-rate. Natural Increase. 1877 1,972 42.0 905 19.2 1,067 1878 2,183 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 1887 2,488 34.2 1,016 14.0 1,472 29 Births. The births registered during the 52 weeks included in the registration year 1887, were 1,278 of males and 1,210 of females. The total number was 2,488 and the consequent birth-rate was 34.2 per thousand inhabitants. This is the lowest birth-rate by two per thousand that it has been my province to record. The birth-rate for the Metropolis during the year was 31 .7 per thousand persons. In the last annual report, the decreased birth-rate of the sub-district was the subject of a special paragraph. The rate for 1885 was 41.1, for 1886 it was 36.2, whilst in 1887 a further diminution of the number of births took place, which reduced the rate for the year to 34 "2. This to a considerable extent will favourably affect the death-rate, as the deaths under one year of age are 39.8 per cent of the total deaths, while from one to five years there was a mortality of 21.1 of the deaths during the year under report. The total under five years of age was 60.9 of the deaths at all ages. As the death-rate among young children is excessive as compared with the later years of life, a lowered birth-rate or what is the same thing, fewer births in relation to the population, consequently tends to a decreased death-rate. Mortality. The deaths registered as occurring in the sub-district during 1887 were, of males 506, of females 510, the consequent total mortality being 1,016. This gives the remarkably small death-rate of 14 per thousand persons, a low rate of mortality which has never been previously recorded in these reports. Table II. illustrates the numbers, causes, ages at death and social position of the deceased. 30 TABLE 11. Statistics of Mortality. EAST BATTERSEA. Population (Census) 1881 64,675 Official Population in middle of 1887, 72,550 Total Deaths from each class of Disease, &c.. in the Sub-district. Sex. Age. Social Position. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. From 10 to 20 years. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. CAUSES OF DEATH. i. Zymotic. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 33 20 13 15 15 3 .. .. .. .. .. .. .. .. 31 Scarlet Fever 18 13 5 2 12 1 2 1 .. .. .. .. .. 2 16 Simple Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 3 1 2 .. .. .. .. .. .. .. .. .. .. .. 2 Puerperal Fever 7 .. 7 .. .. .. .. 2 1 .. .. .. .. 1 6 Diphtheria 8 3 5 2 6 .. .. .. .. .. .. .. .. 1 7 Whooping Cough 58 24 34 23 31 4 .. .. .. .. .. .. .. 6 52 Erysipelas 7 1 6 3 .. .. .. 1 1 1 1 3 1 3 Diarrhœa & Dysentery. 99 54 45 70 18 3 .. .. .. 8 .. .. 1 3 95 Infantile Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Zymotic Diseases 13 10 3 6 2 3 .. 1 .. 1 .. .. .. 2 11 Totals of Zymotic Class 246 126 120 121 84 14 2 12 2 10 1 .. 4 19 223 ii. Constitutional. Gout and Rheumatism.. 2 2 .. .. .. 1 .. 1 .. .. .. .. .. 1 1 Cancer & other Tumours Other Constitutional 14 5 9 .. .. .. .. 1 7 6 .. .. 1 1 12 Diseases 5 2 3 5 .. .. .. .. .. .. .. .. .. 1 4 Tubercular Phthisis 75 31 44 .. 3 1 8 36 23 4 .. .. 2 7 66 Tabes Mesa 73 32 41 55 16 .. 2 .. .. .. .. .. 1 3 69 Hydrocephalus 14 10 4 6 6 1 1 .. .. .. .. .. .. 2 12 Scrofula .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. III. Local. Nervous 121 69 52 32 28 12 2 8 13 22 4 .. 3 19 99 Circulatory 37 18 19 .. .. .. .. 9 13 14 .. 1 1 5 30 Respiratory 226 105 121 69 70 11 3 12 22 35 4 .. 3 32 191 Digestive 20 8 12 3 .. .. 1 2 6 6 2 .. 4 3 13 Urinary 17 10 7 .. 1 .. .. 2 7 7 .. .. 1 5 11 Generative (Parturition) 5 1 4 .. .. .. .. 4 1 .. .. .. .. .. 5 Locomotory 1 1 .. .. 1 .. .. .. .. .. .. 1 .Integumentary .. .. .. .. .. .. .. .. .. .. IV. Developmental. Premature Birth, Low Vitality & Congenital Defects. 102 49 53 100 1 1 .. .. .. .. .. .. 1 2 99 Old Age 21 9 12 .. .. .. .. .. .. 1 10 1 2 5 13 V. Violence 37 28 9 13 5 5 4 2 6 2 .. .. .. 5 32 VI. IIIdefined and Not Specified IIIdefined .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1016 506 510 404 215 47 23 89 101 116 21 2 23 110 881 31 Deaths in A large number of inhabitants die in the institutions, course of each year in various institutions external to the parish. The whole of these persons returned in 1887, numbered 182; including deaths in Union Infirmary, General and Special Hospitals, Hospitals of the Metropolitan Asylums Board, and the County and other Lunatic Asylums, and one case of the body of an East Battersea inhabitant found in the Thames, near Woolwich. If the whole of these deaths be added to those dying within the boundaries of the East Battersea sub-district, a total mortality of 1,198 during 1887 will be deducted. This would give a death-rate equal to 16.6 per thousand for the year. This is the most severe test, as many of these persons were but nominally inhabitants, being employed and domiciled elsewhere, but when admitted into public institutions, giving, as is usually done, the residence of their parents or families. This, however, exhibits a death-rate three per thousand less than that of the Metropolis for the year, that being by the RegistrarGeneral's return 19.6 per thousand. Table III. gives full details of the numbers, ages, and causes of death in Outlying Institutions. It will be observed that but 25 deaths occurred from diseases of the zymotic type. Of these, 15 were from Scarlet Fever, great numbers of persons (in all 167) having been removed to the Metropolitan Asylum Board Hospitals, 14 deaths taking place therein; the other death from this disease being in a general hospital. In all, 69 deaths took place in the Union Infirmary, 88 in General and Special Hospitals, 16 in Metropolitan Asylum Board Hospitals, and 9 in the County Lunatic Asylum. 32 TABLE III. Deaths in Outlying Institutions. EAST BATTERSEA. Sex. Age. Institutions. Total. Male. | Female. Under . 1 to 60. 60 and upwards. Union Infirmary General & Special Hospitals. Asylums Board Hospitals. Lunatic County Asylum. Disease. Small-pox .. .. .. .. .. .. .. .. .. .. Scarlet Fever 15 8 7 .. 15 .. .. 1 14 .. Diphtheria 3 1 2 .. 3 .. 2 1 .. .. Enteric Fever 1 .. 1 .. 1 .. .. 1 .. .. Whooping Cough 2 1 1 .. 2 .. 2 .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Other Zymotic Diseases 4 3 1 1 2 1 1 3 .. .. Tubercular Diseases 31 16 15 1 8 2, 15 14 1 1 Cancer l5 5 10 .. 13 2 4 11 .. .. Rheumatism 1 1 .. .. 1 .. .. 1 .. .. Respiratory Diseases 13 4 9 1 9 3 7 6 .. .. Circulatory Diseases 20 13 7 .. 12 8 9 11 .. .. Nervous Diseases 21 11 10 1 13 7 9 5 1 6 Other Diseases 35 16 19 3 25 7 l6 17 .. 2 Violence 21 15 6 .. 14 7 4 17 .. .. Totals 182 94 88 7 138 37 69 88 16 9 Ages at Under one year of age 404 deaths, equal to 39.8 of the total mortality at all ages took place. From one to five years 215 deaths occurred, comprising 21.1 of the total mortality—together 60.9 of the deaths for the year was recorded in persons under five years of age. The majority of deaths from zymotic diseases, 205, were included in these ages, altogether 619 deaths were recorded within these earlier years of childhood. Above 80 years of age 21 persons died, which is precisely the number certified as dying from old age. 33 TABLE IV. Zymotic Mortality in the East Battersea Sub-district. 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 1887 Small-pox 28 5 1 1 17 .. .. 3 1 .. .. Measles 47 6 47 22 60 33 25 92 49 44 33 Scarlet Fever 18 19 44 63 20 36 17 17 3 9 18 Diphtheria 1 4 6 2 3 7 6 7 8 6 8 Simple Continued Fever 1 17 12 13 15 17 14 14 2 1 .. .. Enteric Fever 2 3 8 10 3 Whooping Cough 26 63 39 43 37 56 53 60 47 62 58 Epidemic Diarrhœa 47 71 43 78 45 37 61 98 63 82 99 Other Zymotic Diseases 22 20 25 13 18 11 19 20 9 19 27 Total Deaths from Zymotic Diseases 206 194 218 237 217 194 185 317 198 232 216 Zymotic Death -rate 4.3 3.7 3.9 4.3 3.7 3.2 3.0 4.9 2.8 3.3 3.3 Death-rate from all Diseases 19.2 17.3 17.5 18.9 16.8 16.4 16.5 18.6 16.0 16.2 14.0 Zymotic Diseases.—Table IV. illustrates at a glance the deaths from diseases of this class during the past decade as contrasted with those of 1887. The population of the latter year may be computed at twice that of 1877 when the table commences, a fact to be borne in mind when comparing the relative numbers, for which due allowance is made in the zymotic death-rate, which was for 1887, the same as that for the preceding year, 3 3 per thousand. Small-pox.—No death resulted from this disease during the year, and no cases were sent into the Hospital. Epidemic Diarrhoea.—This was the most fatal of the z) motic diseases during the year, the number being 99, being the greatest number during the decade. The death-rate for the year from this disease was 13 per thousand. The mortality from this disease was great in London and the country generally, and was coincident with excessive temperature and deficient lainfall, the 34 Variable factors of the disease. It has also been shewn that the frequency and fatality of this disease increases with a high temperature of the source of the water supply, in this case the River Thames, and as long as this is the chief source of supply so long will these conditions induce outbreaks of bowel disorder. As usual the victims were chiefly young children, the majority fed by hand. Seventy died under one year, and eighteen between one and five years. All water and milk should be boiled before being given to young children, especially during an epidemic of diarrhoea. Whooping Cough.—This was a very fatal form of disease, 58 deaths having arisen therefrom, in the majority of cases pneumonia or convulsions are certified as the proximate cause of death. Measles.—Thirty-three deaths were registered from this disease. Many other cases, however, were included in the deaths from Whooping Cough, a close alliance appealing to prevail between the two diseases. The two diseases combined caused 91 deaths, and unfortunately, Sanitary Authorities have at the present but the very slightest control over their spreading, there being no hospital provision for such cases, where sufficient isolation cannot be obtained ; and if this existed there is no power of removal. The same control that exists over Small-pox, Scarlet Fever, and Enteric Fever, all of which formerly caused an immense amount of illness, suffering and death, and which an efficient system of isolation or removal has sufficed to check, were at one time an equally hopeless task to the Sanitarian. Public opinion, which resisted removal to hospital at first even for Small-pox, has recently become more amenable to 35 the desirability of preventing diseases of the infectious class by early removal, where efficient isolation cannot be secured, and it may be anticipated that it will before long acquiesce in the extension of like measures of prevention to all infectious diseases. Scarlet Fever.—Many hundreds of cases of Scarlet Fever have occurred during the year in the sub-district, 1 67 of these were removed to hospital. The number of fatal cases was 18, being very small compared with former epidemics. It may be here mentioned that 15 other persons belonging to the subdistrict died in hospital from the disease. The type of disease has been generally of the mildest character, accompanied by few complications, and in this respect exhibiting a striking contrast to other epidemics of Scarlet Fever. The sanitation of the subdistrict improving year by year, as well as that of the Metropolis generally, may be fairly credited with the less malignant type of the disease, as other zymotic diseases have during the last few years exhibited the same characteristic non-malignancy compared with the outbreaks of twenty years since, when there was a much larger proportion of deaths to recoveries. Diphtheria.—Eight deaths arose from this disease, to which the above remarks as to lessened malignancy during later years especially apply. Puerperal Fever and Erysipelas each caused seven deaths. From Enteric Fever but three deaths were recorded, a distinct proof of greatly improved sanitation. Fourteen cases were removed 10 the Metropolitan Asylums Board Hospitals, of whom one died, 36 TABLE V. Comparative Table of Deaths from Non-Zymotic Diseases for 11 years, 1877-87. Diseases. 1877 1878 1879 1880 1881 1882 1883 1884 1886 1886 1887 Tubercular 193 116 167 248 173 192 175 213 181 202 162 Nervous System, Brain, &c. 32 110 97 110 128 112 119 128 104 120 121 Circulatory (Heart, &c.) 38 52 38 28 53 47 44 53 51 55 37 Respiratory 203 217 271 190 188 258 248 241 303 268 226 Digestive 32 33 32 41 39 23 42 22 36 27 20 Urinary 9 9 11 18 12 20 16 15 16 10 17 Generative, including Penturition 1 3 2 4 7 3 9 4 7 3 5 Locum otory, Bones, &c. .. .. 3 1 .. 2 .. 4 3 2 1 Integumentary .. 1 .. 5 1 1 .. .. 1 .. .. Premature Birth 67 45 55 69 67 63 74 116 82 114 102 Uncertain Seat (Cancer, Syphilis, Dropsy, &c 23 18 21 12 27 15 22 25 36 38 21 Old Age 16 9 20 22 14 18 21 19 22 25 21 Violence 26 25 26 33 24 30 24 18 32 28 37 Not Specified 9 13 17 12 11 14 24 .9 4 5 0 Totals 649 651 760 793 744 798 818 867 878 897 770 Diseases of the Non-Zymotic Class.—The Table appended shews the comparatively slight variation in the annual number of deaths from these diseases. If it be noted that the deaths for 1887 represent the mortality in a population at least twice as great as in 1877, a real diminution will be found to have occurred, and although these diseases are not classed among the directly infectious, still many of them are more or less prevalent and fatal in different localities, shewing that they can to a certain extent be influenced, and all sanitary measures tend to improve the general health and the power of resistance to disease. As an illustration of the influence of certain sanitary measures on some of the constitutional diseases, it may be stated that whenever the sub-soil of a locality has been thoroughly drained, the death-rate from Consumption has greatly diminished, in some instances by one half. This was a wholly unexpected 37 result, but has been the result of thorough and efficient drainage in so many, in other respects, diverse localities, that Sanitary Authorities have long since accepted the facts. Deaths not Fourteen deaths were uncertified during the Certified, year, a decrease compared with former years. In eight instances the Coroner deemed an inquest unnecessary, the cause of death being apparent aud there being no reason to suspect any wrong in either case. There can be no objection to such cases as have been submitted to such an experienced judicial officer, being registered, but it is otherwise in cases where neither Coroner, nor any medical man, has had cognizance of the circumstances. In six cases midwives had been in attendance, all the deceased were infants not exceeding two days old, and the particulars are subjoined Sex. Age assigned. Male 22 hours Male 14 hours Female 6 hours Female 30 minutes Male 3 hours Male 2 days Cause of Death. Fall of Mother before birth. Convulsions. do. Atalectasis. Non irable. Convulsions. It would be much more satisfactory if all cases without medical certificate of the cause of death were submitted to the Coroner. inquests. The Coroner held fifty-two inquests in addition to investigation of eight cases not certified. The results were as follows:— 38 From Natural causes 15 Frem Accidental causes:— Asphixia (Infants in bed 10) 14 Drowned 8 Falls 3 Swallowing a pin, Scald, Blow with Cricket Bat, on Railway, Tram Car, each one 5 — 30 Homicidal:— Suicide, Hanging, Shooting, Drowning, Cut Throat, each one 5 Want of attention at birth 1 Wilful Murder, by exposure 1 — 7 52 The proportion of inquests to total deaths is 51 per cent, which is very satisfactory, as shewing the thoroughly efficient manner in which the high and important duties of his office are carried out in this district by the coroner. Vaccination. The number of cases successfully vaccinated by the Public Vaccinator during 1887 as shewn by the official register is subjoined:— Primary Vaccinations 1,224 Re-Vaccinations 20 Total 1,244 Social The usual table of the social condition of the Position. Persons whose deaths have been registered during the year is interesting, as affording in some measure a test of the relative proportions living in the sub-district. It must, however, be remembered, that the deaths are more numerous in proportion to numbers in the industrial classes as the result of a higher birth- 39 rate, the effect probably of earlier marriages. In 1887 the numbers were:— Nobility and Gentry 2 = .2 Professional Classes 23 = 2.2 Middle and Trading Classes 109 = 10.7 Industrial and Labouring Classes 882 = 86.0 Totals 1,016 100.0 Sanitary The sanitary work done by the Inspectors Operation. during 1887 exceeds that of any former year. The large number of 9,864 inspections has taken place in the Sub-district with the result that 926 first notices were served to remedy 2,599 defects. It became necessary to serve second notices in 203 instances, with the result that such orders required magisterial aid in but five cases, in each of which compulsory orders where obtained and the works executed. Although about the same proportion of notices to abate nuisances to premises inspected has been served during the last few years, yet the nuisances themselves are of a less serious character, and are chiefly defects arising from wear and tear of sanitary apparatus or due to destructive, careless or mischievous habits of the inhabitants in some localities. Houses have been disinfected after infectious disease in 290 instances, a great increase in the number for 1886, when but 73 were so treated, and the result of the prevalence of Scarlet Fever daring the whole of the year under report. No cases have come to knowledge where desease has recurred from failure of such disinfection and time but confirms the thoroughness of the disinfecting process by the method employed, sulphur fumigation. In two instances it was found necessary to destroy 40 ding after fever. Rooms were cleansed and repaired in 65 instances, and staircases and passages in 16 others, in many cases after the recurrence of infectious disase. Drains were cleansed and repaired in 332 instances, syphons were fixed to 244, and 222 sinks altered to discharge over gullies, thus getting rid of direct communication with the sewer. Water closets were cleansed, and a water supply to closets provided in the large number of 522 instances. Four cesspools were abolished, their existence though unused being a fertile source of disease, often of a fatal type. In 328 houses requiring repair and cleansing the necessary works have been carried out by the owners; sixty-five leaky roofs and gutters have been repaired; twenty-five houses supplied with water; 409 cisterns covered and repaired ; affording strong presumptive evidence that their abolition, with a constant water supply would be of great benefit, both as saving expense and by preventing damp and therefore unwholesome houses. One hundred and eighty-one dust bins have been provided. It is to bs hoped that the collection and disposal of household refuse by the parish authorities will shortly render these unsightly and evil smelling receptacles superfluous, and that a frequent collection will render a small metal pail or bin sufficient in capacity for each house. Both from an aesthetic and a sanitary aspect the gain would be great. Three cases in which pigs were kept were promptly dealt with. The population is far too dense in Battersea to allow pigs to be kept in its midst. Accumulations of manure have been removed in 27 cases and stables drained and paved in 13 otheTs, while yards have been drained and paved in 26 instances. 41 The discovery and removal of these sanitary defects represent an enormous amount of labour by the sanitary inspectors, who have now their respective districts well in hand. It is found that continuous house to house inspection is an absolute necessity if a good sanitary state of the sub-district is to be maintained, as inspection will in very numerous cases reveal serious defects which did not exist on the occasion of a previous visit a few months earlier. I have to express my satisfaction at the manner in which Assistant Inspectors Freeman and Poole have performed their duties during the past year. The method of ventilating sewers by upcast shafts reaching above the highest points of the houses to which they are affixed but terminating at a lower level than the chimney tops, has been extended considerably during the past year in the parish generally. When complaint is made of offensive surface street ventilation, the removal of the grating and the adoption of the above plan has in every case removed the noxious emanations complained of. In the case of the Bridge Road Sewer constant complaints of the offensive odours emitted from the gullies and ventilators, which forced their way through the traps of the house drains, had for many years prevailed. The adoption of upcast shafts by the Metropolitan Board of Works has remedied this and not a single complaint has since been received. It is desirable that the svstem should be extended to •/ all cases in which efficient ventilation of the sewers does .not now exist, more especially in the case of the low level main sewer running from East to West through the whole length of the parish, the condition of which has elicited numerous complaints. 42 A complaint was made of noxious emanations from the Cremator at the Dogs' Home in the Battersea Park Road, some time after it had been in use. The original plans were submitted to me for inspection and I had frequently visited the premises but always failed to discover the slightest disagreeable effluvium, greatly to my satisfaction and I must say somewhat to my surprise. The Committee of view visited the premises and found no offensive odour, and enquiry revealed the fact that the effluvium complained of had only been noticed at an early hour in the morning and but for a short time. Comparison of these times with the books of the Home shewed that the Cremator was being filled with the carcases of dogs that had been asphyxiated, and the smell having been likened to that of burnt hair, it was evident that the Cremator had been left open after the animals had been placed therein. This was merely a detail, and greater care having since been taken, no further complaints have been received. Complaints were also received of reported escape of nitrous fumes from a wharf at Nine Elms where nitric and other acids are manufactured. This comes within the Noxious Vapours Act 1881, and the Local Government Board was informed of the facts, with the result that improved apparatus has greatly modified the evil. Many houses erected but a few years since, are becoming ruinous and unfit for habitation'; not so much from age, as from the habits of the class of persons who now inhabit them. In Currie Street and Ponton Road, Nine Elms, several houses were found to have had windows, doors and most of the woodwork destroyed and burnt by tramps and others who took possession of them at night in 43 great numbers, no one being found therein during the day. The pipes were cut away, removed, and the water supply had been cut off. Many of the closets and drains were stopped up. Upon a report by the Surveyor and myself to this effect being presented, an order was made to close the houses, as being unfit for human habitation, which was carried out, and they were subsequently put in a fit state for occupation. Many cases of defects in combined drainage have been dealt with during the year and orders made and carried out for separate drains. In Woodgate Street ten houses were drained by a single pipe which became blocked, in Gladstone Terrace eight houses with only one drain were found in a similar condition, as also four houses in Henley Street; prompt removal of the cause by the provision of separate and distinct drains was enforced. Very few cases of food unfit for human consumption have come to notice during the year. The constant supervision by the Sanitary Inspectors render the street dealers very careful in this respect. Mackerel to the number of 70, two bags of mussels, a trunk of haddocks and two bags of onions were destroyed owing to their decomposed condition. Cow & slaughter- The few premises now licensed in the houses. sub-district have been regularly inspected, have been found to be in a proper and cleanly condition and the renewal of their respective licenses has not therefore been opposed. Bake-houses. The bake-houses have been cleansed in accordance with the regulations, and there is no insanitary condition known to exist in them, all necessary works having been promptly executed. 43 I have again to thank Mr. Pilditch, the Surveyor, for the ready and valuable assistance he has always rendered me. Mr. Richards, the Chief Sanitary Inspector has again merited the highest praise for the energetic yet careful manner in which he has carried out the numerous and important duties entrusted to him. In conclusion, I have to express a hope that the foregoing report will be satisfactory to the Local Sanitary Authorities by whose firm and unvarying support it is alone possible to obtain such results. W. H. KEMPSTER, M.D., Mcdical Officer of Health for East Battersea. 45 west battersea. The year under report has been charaeterised by an unusual prevalence of certain diseases, viz:—Scarlet Fever, Diphtheria, and Throat Affections, the like severity of which has not existed for some years past, these being of the epidemic class, the death-rate from this class of ailment has considerably increased as compared with 1886. The total number of deaths was 256, being 90 more than those of the previous year. It was evident in the first quarter of the year that we were about to be visited by one of those periodical epidemics of Scarlet Fever, which no method of precaution has been able to prevent, these suspicions were unhappily verified by the laige number of cases which subsequently appeared, yet, although, the known numbers were large, there is no doubt the actual cases were far in excess of those which came under notice. In the absence of compulsory notification of the occurrence of infectious disease, the returns relied on are principally those of the Asylum Board, which refer to admissions only, there is therefore no safe basis on which to estimate the actual extent of the disease, though from one's actual knowledge there is no reason to doubt that it was pretty generally and plentifully spread over the whole of the district. What the cause of this disease may be one cannot say. There can be no question but that it is always more or less amongst us, but what the conditions may be which should cause it to suddenly become epidemic, as during the past year, it is impossible to tell. All we can do is to try and discover the circumstances which are favourable to its spread, and by removing them, to stamp out the epidemic before it gets much sway ; to do this, it is absolutely necessary to know where the cases occur 46 in order that the Sanitary Authorities may see that the person is properly isolated, or where that is not possible, that they are removed to hospital, for whilst parents will hide the fact of the disease existing in their children and they are allowed to associate with others and to return to school before the infectious period has passed, so will the disease spread; it is in such cases as these that the compulsory notification would be most valuable the latter subject having so recently been under the consideration of the Board, it is unnecessary, except to again advocate its adoption, to refer further to it. The disease was for the most part of a very mild character, hence, the mortality in comparison to number, was low; and there is no doubt the prompt action in many cases of removing the first patient to hospital has saved many from taking the disease 1 may state that every facility is afforded by the Asylum's Board for removal of patients without delay, and further, that all possible care is taken of the patient in transit and otherwise. As so many removals are now taking place, it may be interesting to the Board to know the various steps taken to place a patient in the hospital. The following is from an exhaustive report written by W. M. Ackworth, Esq., our representative at the Asylum's Board, dated October, 1887, and kindly lent me by R. M. Henley, Esq. " The responsibility of the Asylums Board for a case of infectious disease begins from the moment that application for its removal is made by a Relieving Officer or Medical Officer of Health to the chief office of the Board, in Norfolk Street. Norfolk Street is in telephone communication with the different ambulance stations. If the application gives (as it only too frequently does not) all the needful particulars of sex, age, nature of disease, and address of patient, it is immediately telephoned on to the ambulance station in whose district the patient's place of abode is situated, there a Clerk receives and records it, the Superintendent of the station steps out into the yard and blows his whistle; helpers run out and put to the horse, the driver buttons up his coat and gets on to his box; meanwhile, a massage has been 47 sent through the telephone to the adjoining hospital that a nurse, and if necessary, a second attendant is to get ready, and a ticket has been made out for the delivery to the driver. Seventy-five seconds after the message has been received the station gates swing open and the ambulance trots round the hospital; the nurse gets in taking with her brandy, and if the journey is at all a long one, beef tea and milk as well, and a moment later is on her way to fetch her patient. Arrived at the patient's house, the nurse must first obtain an order signed by a doctor or relieving officer, and then persuade the patient to leave behind everything, money, outside clothing, and belongings of all kinds Dressed only in underclothing, but wrapped in blankets that have come in the ambulance, he is placed in the ambulance and conveyed to the hospital receiving ward." The following will also be read with interest in reference to visits of friends to patients. " Now-a-days, and in ordinary cases no visits whatever are allowed, if a patient is seriously ill information of his condition is sent every day to his friends, only if the case is dangerous are the nearest relatives permitted to enter the hospital. They are wrapped from head to foot iu a linen wrapper provided for the purpose, so that their clothes may not be exposed to infection, and they are not allowed to come into personal contact with the patient. When they leave the wards they must wash their face and hands with carbolic soap, they are urged for their own sakes not to increase their own risk by entering the hospital on an empty stomach, and for the sake of others not to enter any omnibus or other public conveyance immediately after leaving the hospital." From the above extracts it will be seen how extremely careful of communicating infection the managers are. The report in full can be seen in the October number of Murray's Magazine. Other diseases of the Zymotic class which have been more prevalent than usual were Whooping Cough, Diphtheria, and Quinsy, the latter more so than I have ever before known it. Population. The population estimated on the Registrar General's method for the middle of the year would be 70,213. This I think is too low, as it gives a birth rate of 38.4 per 1,000, being 6'7 more than that of London, which was 31.7 per 1,000. 48 Mortality. The total number of deaths returned by the Registrar as having taken place in this sub-district was 1,435—of which 712 were males and 723 females. In 1886, 1,348 were returned ; there is therefore an increase of 87 on that year. In addition to the above, 100 took place in public institutions outside the district, making a total of 1,535 persons who died in and connected with this division of the parish. Of the 1,435, 274 occurred in institutions within the sub-district, viz:—268 in the Infirmary and 6 in the Bolingbroke Hospital; these are two above those of the previous year, when 272 were returned. Of the deaths which took place in the Infirmary, 68 belonged to West Battersea, the remainder to other divisions of the Union. Deducting the 274 deaths in public institutions, 1,161 will be the correct number for this out-door district.* * Out-door with reference to Infirmary. The number of deaths registered in each quarter of the year was as follows:— First Second Third Fourth Quarter. Quarter. Quarter. Quarter. 356 304 385 390 Total deaths from all causes, including all deaths in the Infirmary in the respective years were :— 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 1887 820 908 1002 1010 1195 1222 1341 1319 1395 1348 1435 The deaths in the Infirmary were 268—males, 136 ; females, 132. 49 The death rates per 1,000, including Infirmary deaths belonging to this sub-district and outlying Institutions: — 1877 1878 1879 1880 1831 1882 1883 1884 1885 1886 1887 17.1 18.5 20.0 16. 6 19.0 18.0 18.6 18.8 19. 8 18.1 18.9 The deaths during the past year, not including those occurring in its Institutions, nor those in outlying Institutions, numbered 1,161; these give a death rate of 16.5 per 1,000. Biith rate. The number of births registered were 2,698; of which 1,398 were males and 1,300 females, being a difference of 98 in favor of the males, and total increase of 81 above those of the previous year. The rate is 38.4 per 1,000, being 1.4 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. 637 671 659 701 Natural The above number of births are 1,469 in increase. 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:— 50 TABLE I. WEST BATTERSEA Population (Census) 1881 52,587 Official Population in middle of June, 1887 70,213 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. N obility and Gentry Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial and Labouring CAUSES OF DEATH. I. Zymotic. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 46 27 19 6 33 5 1 1 .. .. .. .. .. 3 43 Scarlet Fever 30 16 14 .. 17 10 3 .. .. .. .. .. .. 2 28 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever . 14 7 7 .. 2 3 3 2 4 .. .. .. 2 1 11 Puerperal Fever 9 .. 9 .. .. .. 2 7 .. .. .. .. .. 3 6 Diphtheria 15 8 7 1 5 7 2 .. .. .. .. .. .. 2 12 Whooping Cough 54 19 35 20 32 2 .. .. .. .. .. .. 1 2 51 Erysipelas 12 4 8 2 .. .. 1 1 3 3 2 .. .. 1 11 Diarihœa, Dysentery, and Cholera 76 41 35 64 10 .. .. .. 1 .. 1 1 .. 8 67 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 256 122 134 93 99 27 12 11 8 3 3 2 3 22 229 II Constitutional. Gout and Rheumatism. 16 8 8 .. 1 2 1 3 4 5 .. .. .. 6 10 Cancer & other Tumours 33 9 24 .. .. .. .. 2 17 14 .. 2 1 7 23 Other Constitutional Diseases 21 6 15 8 .. 1 1 4 1 6 .. 3 1 2 15 Tubercular Phthisis 126 84 42 1 2 .. 6 54 48 15 .. .. 5 11 110 Tabes Mesa 53 32 21 33 10 3 3 3 1 .. .. 2 .. .. 51 Hydrocephalus 15 11 4 6 8 1 .. .. .. .. .. .. .. 1 14 Scrofula 11 5 6 8 .. 1 1 1 .. .. .. .. .. 3 8 III. .Local. Nervous 159 76 83 47 21 1 7 9 28 40 6 3 1 12 143 Circulatory 91 36 55 2 1 1 .. 15 29 36 5 2 3 9 77 Repiratory 302 144 158 65 70 17 4 21 41 65 19 6 5 27 264 Digestive 66 36 30 23 5 3 2 7 14 10 2 1 2 7 56 Urinary 36 21 15 .. 2 1 1 10 18 4 .. 2 1 7 26 Generative 14 .. 14 .. .. .. .. 9 4 1 .. .. .. 4 10 Locomotory 23 12 11 3 5 1 4 2 2 6 .. 1 1 .. 21 Integumentary 6 4 2 1 .. .. 1 1 2 1 .. .. .. .. 6 IV. Developmental. Premature Birth and Low Vitality 100 61 39 99 1 .. .. .. .. .. .. .. 2 10 88 Congenital Defects . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Old Age 67 19 48 .. .. .. .. .. .. 40 27 9 •• 7 51 V. Violence 26 17 9 13 .. .. 2 6 4 1 .. .. .. 2 24 VI. Illdefined and Not Specified Illdefined 14 9 5 6 3 .. 1 2 2 .. .. .. .. 1 13 Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1435 ,712 723 408 228 59 48 160 223 247 62 33 25 138 1269 * Including the deaths in the Workhouse Infirmary for the whole of the WandsworthDistrict. 51 Zymotic Mortality. The deaths from this class of disease were 256, of which 122 were males and 131 females, and are 90 more than those of the previous year. The greatest fatality was from Whooping-cough, Diarrhoea, Scarlet Fever, Diphtheria and Measles, which collectively gave 231 of the total number. From Fevers other than Scarlet and Measles there were 23 deaths, classified as follows;— Typhoid or Enteric 14 Puerperal 9 23 Of the total number 93 were under 1, 99 from 1 to 5 years of age, 39 from 5 to 25, and 24 from 20 upwards. No less than 192 of the total 256 were under 5 years of age, again 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. 1878 1879 1880 1881 1882 1883 1884 1885 1886 1887 Small Pox 2 2 .. 4 1 .. 2 1 .. .. Measles 34 43 8 50 30 52 42 63 26 46 Scarlet Fever 4 55 30 25 35 26 14 5 5 30 Diphtheria 4 7 3 9 4 2 11 2 3 15 Enteric Fever 16 27 10 10 14 12 20 9 13 14 Wooping Cough 36 11 23 31 47 .. 46 74 42 54 Epidemic Diarrhœa 41 17 61 53 39 64 82 63 70 76 Other Zymotic Disease 14 12 11 16 24 16 34 17 7 21 Total Deaths from Zymotic Diseases 150 174 146 198 194 218 251 234 166 256 Zymotic Death rate 3.8 4.2 2.9 3.8 3.6 3.6 4.0 3.6 2.4 3.6 Death rate from all Diseases 18..5 20.6 16.3 19.0 18.0 18.6 18.8 19.8 18.1 18.9 52 Other causes of Death than Zymotic. From these classes 1,179 deaths were returned, being 3 less than those of last year. There were 160 from Bronchitis, Pneumonia, 96. Other Lung Diseases, 46; from Circulatory Disease, 91; Brain and Nerves, 159; Digestive Organs, 66; Premature Birth, Low Vitality, 100; Old Age, 67; Cancer, 33; Violence, &c., 26 Premature Birth, and Disease of Digestive Organs, show an increase as compared with last year, while those of the Respiratory Organs, Old Age, Brain and Nerves, a decrease. From the Tubercular Class, 205 were returned, viz:— Phthisis, 126; Tabes Mesenterica, 53; Scrofula, 15; and Hydrocephalus, 11. Of those from Phthisis, 9 were under 20; and 117 from 20 to 60 years of age. The deaths from Old Age were 67, against 74 of last year, the eldest being females —95, 90, 90, 90, 90, 90, 90, whilst one male reached the great age of 95 years. Reverting now to the opposite extremes of the duration of life, we find that in 12 instances it was a few minutes; 27, a few hours, and in 83 a few days. The following table contrasts all deaths from nonzymotic causes during the past 10 years. 53 1878 1879 1880 1881 1882 1883 1884 1885 1886 1887 Tubercular, including Phthisis 143 163 196 210 198 255 266 239 237 205 Of Brain, Nerves, &c 137 136 117 147 173 168 170 178 169 159 Of the Heart, &c 53 56 72 94 83 85 95 108 104 91 Of the Respiratory Organs, excluding Phthisis 204 260 215 266 272 318 248 327 315 302 Of Digestive Organs 27 27 47 59 59 68 63 52 69 66 Of Urinary Organs 10 20 15 26 21 32 19 30 21 36 Of Organs of Generation 3 9 9 14 14 11 12 16 11 14 Of Joints, Bones, &c 2 2 3 15 12 19 12 5 18 29 Of Cancer 23 14 22 21 25 33 17 33 31 33 33 Premature Birth, Low Vitality, Malformation, &c. 31 36 70 37 78 30 55 61 100 Of Uncertain Seat and other diseases 29 17 36 27 27 13 39 29 24 30 Age 58 57 35 31 37 64 45 54 74 67 Violence 28 13 23 40 30 20 39 29 35 26 Constitutional 11 16 4 10 6 7 10 8 11 21 Totals 751 828 864 997 1028 1123 1068 1161 1182 1179 Of the 1,179 deaths,590 were those of males and 589 of females. Of persons dying in Institutions without this sub-district, though belonging to it, were 100; the cause of death was as follows:— TABLE IV. Deaths in Outlying Institutions. WEST BATTERSEA. Sex. Age. Institutions. Total. Male. Female. Under 1. 1 to 60. 60 and upwards. Union Infirmary General & Special Hospitals. Asylums Board Hospitals. Disease. Small Pox .. .. .. .. .. .. .. .. .. Scarlet Fever 14 5 9 .. 14 .. .. .. 14 Typhus Fever .. .. .. .. .. .. .. .. .. Enteric Fever 3 1 2 .. 3 .. .. 2 1 Diphtheria 3 1 2 1 2 .. .. 3 1 Whooping Cough .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases 3 2 1 1 2 .. .. 3 .. Tubercular Diseases 15 7 8 1 13 1 .. 13 2 Cancer 9 4 5 .. 9 .. .. 9 .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 10 4 6 3 6 1 .. 10 .. Circulatory Diseases 3 2 1 .. 3 .. .. 3 .. Nervous Diseases 8 5 3 .. 8 .. .. 8 .. Other Diseases 22 15 7 6 13 3 .. 22 .. Violence 10 19 1 .. 7 3 .. 10 .. Totals 100 55 45 12 80 8 .. 93 17 54 Inquests. Enquiries were made on the bodies of 34 males and 26 females, in all 60; this being 4 less than those of the previous year. The verdicts were as follows:— From Natural Causes 30 ,, Accidental 21 Found Drowned 2 ,, Dead 1 Suicides 3 Murder 2 Open Verdict 1 60 Of the Accidental causes—4 was by falls, 1 burn, 3 drowned, 8 suffocated, 1 run over, 1 killed on railway, 3 want of attention at birth. The suicides were—cut throats 2, 1 shooting himself, all of unsound mind. The verdicts of wilful murder against some person unknown were of newly born infants, both were found in Gorst Road. The open verdict was on the girl burnt to death in Battersea Park Road. September 23rd. Found at 55, Gorst Road.—Strangulation by putting a cord round her neck. Wilful murder against some person or persons unknown. November 3rd, Found in a blank cellar at 23, Gorst Road.—Fracture of skull by violence, Wilful murder, not sufficient evidence to show by whom caused. In addition to the above inquests, 12 cases of sudden death were submitted to the Coroner, who after due investigation, did not deem an inquest necessary. 55 Of infants suffocated in bed with their parents there were 5, as follows:— Saturday, January 22nd. Monday, June 13th. Sunday, September 25th. Saturday, November 19th. Sunday, December 18th, There were 3 other cases of suffocation of infants— 1 at its mother's breast, 1 whilst lying on its face, and 1 by being delivered in a pail containing water. Deaths not Certified. It is most gratifying to observe that the number of persons who die without qualified medical attendance is reduced to as low a standard as it can well be; a very few years ago it was the regular yearly duty to record upwards of a hundred such deaths, this year they are but 4, and those the bodies of infants who survived their birth only a few moments, whose mothers had been attended by mid-wives. Social Position. The per-centage of deaths in relation to social position was as follows:— Nobility and Gentry 33 = 2.30 Professional 25 = 1.74 Middle and Trading Class 130 = 9.62 Labouring 1239 = 86.34 1435 = 100.00 Sanitary Matters. Perusal of the summary of Sanitary operations page 23 will show the amount of work carried out in this sub-district. The large number of 8,679 houses have been inspected, resulting in a considerable number of defects being discovered, to remedy which 857 first notices were served. In 236 cases it was 56 necessary to serve a second notice, after which all but 5 were complied with, in the latter cases the magistrate was applied to, who issued his compulsory order, which had the desired effect. The occupiers of houses are glad to see the Inspector, knowing his duties are such as tend to the promotion of their own comfort and welfare; there are not more than six instances in which they have been refused admission. Owing principally to the epidemic of Scarlet Fever which has prevailed during the greater part of the year 322 houses have been disinfected after infectious disease, this is a considerable increase on the previous year when 54 were so treated. I may remark that the result of these disinfections still further confirms my confidence in the method we use. To 397 closets, water was laid on, 249 cisterns were covered and repaired, 454 drains cleansed, 320 unwholesome houses cleansed and 129 dust-bins provided, &c., &c. The whole forming an immense amount of work, the value of which it is scarcely possible to conceive. Explosion in Sewer in Church Road. On April 25th an explosion took place in the above sewer, causing a considerable amount of damage, and attended with serious danger to any person who might be in the sewer or passing at the time of the explosion. An investigation was made by the Surveyor and myself and the following observations submitted to the Local Committee. Gentlemen, With reference to the request of the Board of Works for the Wandsworth District, to report to the Battersea Local Committee on an explosion which occurred on Monday April the 25th, in the sewer in Church Road, Battersea, at 3 p.m. We have to observe that the effects of the explosion was to blow off and break the side entrance cover to the man-hole opposite Frances Street, and lifting the cover and stonework to the side entrance opposite Messrs. Morgan's premises; it was also found that the other side entrances had been blown open and the gratings in the centre of the road 57 blown out of their casings by the force of the explosion. So far as the sewer proper is concerned, there does not appear to have been any damage, to cause the explosion there must have been some inflammable explosive gas existing in a free state in the sewer, the origin of which is somewhat difficult to ascertain. On inspecting the sewer to-day it was found to contain a large quantity of the vapour of naphtha. If this same gas was present on the day of the explosion it is quite sufficient to account for what occurred. Again there might be some leakage from the numerous gas pipes as in the case at Putney some few years ago, which might have found its way into the sewer, but there is no smell of ordinary burning gas in the sewer at the present time. Sewer gas is in itself explosive and more so if mixed with coal gas, but in the absence of any coal gas smell, and the sewer being quite clean, having been recently flushed, we do not think this could have been the matters exploded. In the absence of any positive evidence as to what kind of gas was present in the sewer at the time of the explosion it would be simply conjecture to hazard an opinion as to its nature, at the same time if naphtha vapour is to be permitted to prevade this sewer or any other sewer to the extent it docs on various occasions then an explosion may be anticipated at any moment. What the immediate cause of the explosion was, it is difficult to say. A light such as a workman lamp, a lighted match thrown down the sewer, or any inflammable oil floating down in a burning condition would of course be quite sufficient to fire the gas, but in the absence of any direct evidence that any of these existed it is impossible to say in what way the gas was fired As previously stated all the covering to the man-holes was blown open with the exception of the one at Francis Street, which was shattered, this having been complained of, has not been open for some time since, thus forming with the man-hole a closed receptacle in which the explosive gas mast have accumulated as it evidently received the greater force of the explosion—This we should recommend to be entirely done away with or more frequently used—with respect to the others being the weaker part of the sewer, they suffered accordingly. Seeing then that the sewer does at certain times contain the vapour of naphtha— the question arises—whence does it come — we believe it is from the well pumping at the new Battersea Bridge—and for this reason—that when the water from the well is directed into the river, the sewer in Church Road and Bridge Road, is free from naphtha smell, but so long as the water is pumped into the sewer in Bridge Road, on account of the high tide, there it, as well as the Church Road sewer is charged with naphtha vapour. We have examined the well or sump at the Bridge, and found it contains a considerable quantity of naphtha. We would recommend that the company be requested to discontinue the pumping from the swamp into the sewer—not only for the reason mentioned above, but also on account of the odour which is given off when passed into that channel. On ceasing to pump into the sewer all vapour of naphtha ceased, and there has been no further complaint of nuisance—there is therefore presumptive evidence that therein laid the source of the explosion. Water supply. Dead Ends again, complaint was received of offensive smell proceeding from the water delivered into the cisterns in Winstanley Road near the Station End. On examination, the water was found to be turbid 58 and gave off an offensive odour, and illness in several families was attributed to it. The water company was communicated with the plug at dead end of the main situate close by was opened, the people advised to empty their cisterns, and Mr. Richards visiting next-day he found all of the complaints had been removed, clearly pointing to the accumulations of organic matter in the neglected dead end as the cause, though not altogether admitted by the company Overcrowding. But five instances of overcrowding were discovered, the two following are examples A front room upstairs in M Street, was found to contain 1,500 cubic feet of space, in it were living and sleeping— Father. Mother. Two grown up daughters. Two grown up sons. Five younger children. eleven in all, giving 140 cubit feet of space for each person. In the back room of same floor containing 890 cubic feet, were found living and sleeping— A widow, her daughter and child. A man about 20 years. A girl aged 15 ,, ,, 11 ,, equal to 150 cubic feet each person. Notice was served and the overcrowding at once abated. The following will show how difficult it is at times to discover the cause of complaint of objectionable smells and from what unexpected source they may arise. An offensive smell was alleged to prevail at uncertain times in the drawing room of Culmvale, St. James' Road, 59 but seldom noticeable when the Inspector called. The drains were first thought to be the cause, and upon notice being served they were opened up and examined, but no defect was found. Several letters of complaint were again received, the occupier notifying his intention to leave the house on account of it. The Inspector at last happened to call when the smell was on, and ca ns to the conclusion, that it was sulphuretted hydrogen, and probably produced by water dropping on to red hot bricks. Upon the kitchener in the next room being removed this was found to have been the case, upon re-setting no further cause of complaint was made, this discovery reflects much to the credit of Mr. Richards. Bakehouses. All the bakehouses were inspected and found to be in proper order. Two new ones were opened during the year, neither of which were in accordance with the Bake-house Act, 1883. Notice was served to carry out the necessary alterations, which was complied with. Cow and Slaughter-houses were all inspected, and found to be in a satisfactory condition. Mortuary. The mortuary has again been in considerable requisition, 118 bodies having been placed in it, 4 of which were for sanitary purposes, it is now generally known that it is open for the use of all medical men. and most post-morten examinations are made in the room fitted up for that purpose. As this under present arrangements is the last report I shall have the honor to submit to the entire Wandsworth District, I cannot close it without expressing my very grateful thanks for the assistance I have always received, not only fro.n the members of the Battersea Division, but also from those who constitute the Board generally, 60 now extending for a period of nearly twenty years in carrying out my duties and though separated as a district, shall always be pleased to render any assistance should such be required. In taking a retrospect of the past 20 years, the board and its officers may congratulate themselves on the excellent sanitary state the parish now enjoys, time was when, except the main thoroughfares, the bye ones were but a series of dirty lanes, with vehicles, scarcely passable. Now we have fine open streets well made up, paved, drained and lighted. Of course we have a much larger population, and mostly of the labouring class, whose occupations render them perhaps susceptible to illness, yet notwithstanding this, and the crowded state in which we live, the Board may congratulate themselves on the beneficial effects of their labours, and fairly lay claim to a substantial reduction of the death rate, and to have given each person a prospect of five years extra longevity of life as compared with 20 years ago. I trust we may continue to improve, and I feel sure that all officers will continue to put forth their efforts to that end. I have to express my satisfaction at the way in which the Assistant Inspectors do their work, and also to Mr. Richards, whose knowledge of most intricate sanitary matters, and the tact he displays in carrying them out is invaluable. J. OAKMAN Medical Officer of Health for West Battersea. 61 CLAPHAM. Population. The population of Clapham, as estimated by the plan adopted by the Registrar-General was 43,045 in the middle of 1887, being an increase of 1,100 for the year. There is every reason to think, however, that the increase of the population of Clapham has been greater than is shewn by this estimate, and that the following death-rates, &c., are more unfavourable to Clapham than the real facts (if known) would justify. Birth and Birth - rate. The number of births registered was 1,136, 539 of boys, 597 of girls. The annual birthrate was 26.3 per thousand of the estimated population, which with the exception of the two previous years, was the lowest for eleven years (Table I.). 62 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 26.8 544 14.5 14.3 1883 10,85 28.2 580 15.1 13.1 1884 1,123 28.3 543 13.7 14.6 1885 1,030 25.2 508 12.44 12.7 1886 1,071 25.5 545 12.99 12.5 1887 1,136 26.3 600 13.93 12.4 Deaths and Death-rate. During the year 1887, 600 deaths, 293 of males and 307 of females were registered in the sub-district. These are equivalent to a death-rate of 13.93 per thousand as compared with 12.99 in the previous year. The death-rate for the whole of London during the same period was 19.6 per thousand inhabitants. Deaths in Outlying Institutions. The deaths already enumerated do not include those of inhabitants of this sub-district who have died in out-lying institutions. In the following table, these additional deaths, 93 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. 63 TABLE IT. Deaths in Outlying Institutions. DISEASE. Total. Sex. Age. Institutions. Male. Female. Under 1. 1 to 60. 60 and upwards. Union Infirmary. General & Special Hospitals. Asylums Board Hospitals. Small-pox .. .. .. .. .. .. .. .. .. Scarlet Fever 2 1 1 .. 2 .. .. .. 2 Diphtheria 1 1 .. .. 1 .. .. 1 ... . Enteric Fever 1 1 .. .. 1 .. .. 1 .. Whooping Cough 3 1 2 .. 3 .. 3 .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases .. .. .. .. .. .. .. .. .. Tubercular Diseases 20 11 9 .. 18 2 13 5 2 Cancer 6 1 5 .. 5 1 2 4 .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 14 9 5 1 9 4 8 3 3 Circulatory Diseases 10 5 5 .. 6 4 8 2 .. Nervous Diseases 18 10 8 1 13 4 8 6 4.. Other Diseases 13 6 7 .. 8 5 5 7 1 Violence 5 3 2 1 3 1 .. 5 .. Totals 93 49 44 3 69 21 47 34 12 Corresponding Totals for 1886 77 44 38 4 45 28 35 37 5 It will be seen that 47 of the external deaths occurred in the Wandsworth and Clapham Union Infirmary, 34 in various general and special hospitals, and 12 in the Asylums' Board Hospitals. If these 93 deaths be added to the 600 occurring in Clapham, the death-rate becomes 16.5 per thousand as compared with 14.8 in the preceding year. Deaths occurring in Clapham. The following table gives a summary of all the deaths registered as occurring in this subdistrict during the past year, classified according to cause, sex, and social position; and a more detailed list of the deaths from zymotic diseases. 64 STATISTICS OF MORTALITY. CLAPHAM. Population Census 1881 36,380 Official population in middle of 1887 43,045 CAUSES OF DEATH. Total deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. From 10 to 20 years. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c Industrial and Labouring Class. I. Zymotic. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 25 13 12 10 14 1 .. .. .. .. .. .. .. 4 19 Scarlet Fever 3 2 4 .. 4 1 1 .. .. .. .. .. .. 1 5 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 4 2 2 .. .. 1 .. 1 .. 2 .. .. .. 1 3 Puerperal Fever .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 10 1 9 .. 6 2 2 .. .. .. .. 1 1 1 7 Whooping Cough 25 8 17 6 18 1 .. .. .. .. .. .. 1 4 20 Erysipelas 6 2 4 1 .. .. .. 2 1 1 1 1 1 2 2 Diarrhoea, Dysentery, and Cholera 24 10 14 18 4 .. .. .. 1 1 .. 1 2 4 17 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 100 38 62 35 46 6 3 3 2 4 1 3 7 17 73 II. Constitutional. Gout and Rheumatism 9 3 6 .. .. .. 1 3 2 2 1 2 2 .. 5 Cancer & other Tumours 30 11 19 .. .. .. .. 2 11 15 2 4 9 8 9 Other Constitutional Diseases 7 6 1 1 .. .. .. 2 3 1 .. .. 3 1 3 Tubercular Phthisis 43 25 18 1 1 .. 4 16 17 4 .. .. 14 12 17 Tabes Mesa 12 5 7 7 3 1 1 .. .. .. .. .. .. 1 11 Hydrocephalus 13 6 7 1 7 2 2 .. 1 .. .. .. 1 1 11 Scrofula 7 6 1 2 3 .. 1 1 .. .. .. .. 1 .. .. III. Local. Nervous 81 47 34 15 10 .. 1 2 23 26 4 10 17 8 46 Circulatory 52 28 24 1 .. 1 1 4 22 19 4 7 11 10 24 Respiratory 110 42 68 17 34 .. 2 5 12 31 9 10 17 16 67 Digestive 46 25 21 15 .. 1 4 8 8 10 .. 1 8 12 25 Urinary 14 10 4 .. .. 1 1 1 2 5 4 3 1 3 7 Generative 2 .. 2 .. .. .. .. 2 .. .. .. .. 2 .. .. Locomotory .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumentary 1 1 .. .. 1 .. .. .. .. .. .. .. .. 1 .. IV. Developmental. Premature Birth and \ Low Vitality.. > 46 28 18 44 2 .. .. .. .. .. .. 1 8 8 29 Congenital Defects ) . Old Age 18 6 12 .. .. .. .. .. .. 4 14 9 3 2 4 V. Violence 9 6 3 .. 2 .. .. 3 3 1 .. 1 1 2 5 VI. Illdefined and Not Specified Illdefined Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 600 293 307 139 109 12 21 52 106 122 39 51 105 102 342 65 Ages at Death. Of the total deaths 46.8 per cent occurred at various ages below 20 years; 41.3 per cent of which were under the age of 5 years. The deaths of persons over 60 years formed 26.8 per cent of the total deaths as compared with 28 per cent in the previous year. The proportion of deaths under 1 year to the population under that age (i.e. the number of births for the last and the preceding year divided by two) represents the true infantile death-rate. This was 126 per thousand births as compared with 142 per thousand in the previous year. Social Position of Deceased. The relative number of deaths in the several social grades were as follows:— Nobility and Gentry 51 = 8.5 per cent. Professional Class 105 = 17.5 „ Middle and Trading Class 102 = 17.0 ,, Industrial & Labouring Class 342 = 57.0 ,, As is usually the case, the labouring classes suffered greatly in excess of their relative numbers from zymotic diseases, as indicated by their mortality. Zymotic Diseases. The following table gives the number of leaths from specific fevers, as eompared with previous years, and a similar comparison of zymotic and 66 general death-rates. The zymotic death-rate was 2.32 per thousand, or including the 7 deaths in external institutions, 2.53 per thousand of the estimated population. TABLE IV. Zymotic Mortality in Clap ham. 1878 1879 1880 1881 1882 1883 1884 1885 1886 1887 Small-pox 3 .. 2 7 1 .. 2 .. .. .. Measles 23 17 19 10 15 33 33 3 11 25 Scarlet Fever 12 12 21 15 26 8 3 .. 1 6 Diphtheria 3 1 3 3 4 7 8 4 6 10 Enteric Fever. 5 9 4 3 7 3 4 8 3 4 WhoopingCough 29 25 25 13 17 16 15 25 34 25 Epidemic Diarrhœa 26 17 36 20 4 19 18 16 25 24 Other Zymotic Diseases 9 21 9 7 7 26 12 5 4 6 Total deaths from Zymotic Diseases 110 102 119 78 81 112 95 61 84 100 Zymotic Deathrate 3.4 3.1 3.4 2.1 2.1 2.9 2.3 1.49 2.00 2.32 Death-rate from all Disease 18.1 17.0 14.9 13.5 14.5 15.1 13.7 12.4 12.9 13.93 During the year 1887, 10 deaths from Diphtheria have occurred in Clapham, and 1 of a Clapham inhabitant in an outlying institution. Altogether 20 cases have come to our knowledge in 13 houses. 67 The date, locality, and other particular of these 20 cases are given in the following table:- Date of Onset. Address. No. of Cases. School Attended. Drains History of Infection. Result of Case. Remarks. Feb. 15 Great Acre Court, close to Park Road 1 - Defective None Recovered Defective hopper-closet: sewer gas escaping in w.c. Aug. 29 Chale Road 1 Lyham Road Board Obstructed None Died Drain being completely obstructed, was opened a few days before the case broke out. „ 31 Chale Road 1 Lyham Road Board Obstructed None Recovered This house drained with the last & same obstruction Sept. 1 Clapham Common 3 - Obstructed None ,, House drain completely filled with filrils of tree roots and wall of house sodden with sewage. 17 Chale Road 4 New Park Road Board No defect discoverable None 1 Died Child came home ill from school and complained of smell in school closet. Inspector on visiting the school a few days later, found it closed and men at work relaying the drams. Oct. 12 Lyham Road 1 - No defect apparent None Died „ 24 Lyham Road 1 - No defect discoverable None Died ,, 30 King's Road 1 At same address Defective None Died Two sinks opened directly into house drain: 1 in kitchen, and 1 on staircase near bedroom. No further cases in the school. Nov. 10 Kingswood Road 1 Private School at Streatham No defect proved None Died „ 28 Thornbury Road 3 Lyham Road Board No defect proved None 2 Died First case in the house started Nov. 28th, second on Dec. 9th, third on 23rd. Dec. 23 Thornbury Road 1 Lyham Road Board No defect proved None Died Several other children house, but only one took Diphtheria. „ 23 Endlesham Road 1 Aldridge Road Board No defect proved None Died „ 31 Pickett Street 1 Do. - - Died This case was certified by Coroner, and may no. have been Diphtheria. 1888. Jan. 18 Thorncliffe Road 1 None Defective None Died Defective bath drain. which is separate from w.c. drain. On the evening when the child was taken ill 15 other children were at a party at the house. „ 29 Thorncliffe Road 1 None No defect proved None - 68 It will be seen that there was a close aggregation of cases in Thorncliffe, Kingswood and Chale Roads All the houses in these roads (68 in number) have been within the last few weeks re-inspected. In 6 of the 68 houses Diphtheria has occurred, 4 cases being fatal. The houses in question are occupied by 260 adults and 171 children, and the duration of occupation by the present 68 tenants is as follows:—over 4 years 1, over 3 years 12, over 2 years 34, over 1 year 11, under 1 year 10. No Diphtheria occurred in these houses from January 1885 to August 1887. At the latter date the first of the present crop of cases in this locality occurred. In 3 of the 6 infected houses, the drains were or had been defective, in another case the school attended by a child who died of Diphtheria had been shut up for drain repairs. Thornbury Road has not yet been specially re-inspected, but in the houses in that road where the cases of Diphtheria occurred, no special defects have been discovered. The origin of the milk supply has been carefully examined in each case: it is so varied, as to preclude any possibility of its being a common source of infection. The main sewers in these roads have been inspected and found to be in a good sanitary condition, well flushed and efficiently ventilated. The fact that an old slop-shoot existed behind the present site of Chale Road deserves note, but it is impossible to explain the immunity from Diphtheria for the 4 or 5 years since these houses were built until August 1887, on the supposition that this was the cause. It should be remembered that Diphtheria has been prevalent in some excess throughout London during the 69 past few months, but there must be some local cause to account for its special incidence on this part of Clapham. Local obstruction of several house-drains seems in a few cases to have been the exciting cause: and it is highly probable that direct infection accounts for others. Scarlet Fever was the cause of 6 deaths in the subdistrict, and 2 in out-lying institutions. This is equal to a, death-rate of 0.18 per 1,000 of the estimated population, as compared with 0.34 per 1,000 for the whole of London, and 0.43 in the 27 chief provincial towns. 55 cases of Scarlet Fewer were admitted from Clapham into the Asylums' Board Hospitals, as compared with 22 in the previous year. The Scarlet Fever epidemic which has prevailed throughout London during the latter half of the past year has been of a peculiarly mild type. The death-rate for the whole Metropolis from Scarlet Fever, although showing a considerable increase on the corresponding rates for 1885 and 1886, was lower than in any previous year of which record exists, and was very little more than half the mean annual rate during the years 1871-80, which again was little more than half the mean rate in 1861-70. It will be seen also that although there has been a considerable amount of Scarlet Fever in Clapham, its death-rate from that disease was only half that of the whole Metropolis from the same disease. The continued spread of this disease is due to two causes which are in some measure complementary; the carelessness and apathy of poorer people in regard to the spread of infection: and the lack of compulsory notification of infectious diseases, which prevents the sanitary officials dealing with an epidemic in its earliest stages, thus obliging them to stand in the position of the man who closes the stable-door after the horse is stolen. 70 I have in various fortnightly reports given instances of the extreme carelessness as to spread of infection which prevails. In one case we were able to obtain the conviction of a woman who sold the bedding on which her daughter had died from Scarlet Fever, without any previous disinfection. In another case a boy was found to be attending school within a week from the commencement of a slight attack of Scarlet Fever. There can be little doubt that in other cases the too early return of children to school after infectious diseases is an occasional cause of their spread, and that the system of sending scholars to visit absentees is most ojectionable for similar reasons. It may be hoped that the spread of education, particularly the teaching of elementary Physiology and Hygiene will gradually lead to wider knowledge and greater conscientionsness in these matters. The table on page 66, shews that Measles, Whooping Cough and Diarrhoea were the most fatal of the zymotic diseases, and it is in the prevention and treatment of these so-called mild diseases that the working classes are preeminenty ignorant. Children scarcely convalescent from Measles or Whooping Cough are exposed to bleak winds, and consequently die from chcst affection ; while Diarrhoea carries off numerous infants, who with greater care in artificial feeding might have been saved. inquests. Twenty-two inquests were held during the year, and the following verdicts returned:— 1, From, Natural Causes 14 2, Accidental—Burn 1 Injury to Brain 1 Overdose of Chloroform 1— 3 3. Suicidal,—Drowning 1 Cut-throat 1 Cut veins of arm 1 Hanging 1 Carbolic acid Poisoning 1 — 5 Total 22 71 Five uncertified deaths occurred durring the year, two of these being registered on a letter being received from medical men who saw the case after death; and three on the authority of a letter received from the coroner. One of the latter cases was stated to be Diphtheria, but it is difficult to understand how the coroner could make such a diagnosis, as he did not see the patient either before or after death. Sanitary Proceedings of the year. The number of houses inspected during the year was 3,53l, as compared with 3,919 in the previous year. The table on page 23, gives a statement of the nuisances dealt with, which can be conveniently tabulated. In addition to the 3,531 ordinary inspections made during the year, 2,047 special inspections were also made to ascertain the amount of house refuse requiring removal, prior to the expiration of Mr. W. Boyce's contract. The total number of nuisances dealt with amounted to 2,767; of these 2,367 were abated under notice and 398 under promise. The number of unclassified nuisances were 261 viz:— 46 new ventilating pipes, 17 ventilating pipes repaired, 21 soilpipes repaired, 65 closet valve airpipes removed from inside drinking water cisterns, 50 leaky water fittings repaired, 2 cases of water in basements, 2 water closets rebuilt and ventilated, 4 new sinks, 2 piggeries cleaned and limewashed, leaky gas-fitting, privy removed, smoke nuisance, carpet beating, foul bedding, animals kept in dwelling houses, 2 horses and 1 donkey, animals kept in an unsanitary condition, 3 cases of goats, 1 case of ducks, rabbits and pigeons, 41 dirty bake-houses. 72 The Cow-sheds and Slaughter-houses were inspected during September, and their sanitary condition found satisfactory. The Bake-houses were inspected twice during the year. In April 12 required cleansing and limewhiting, and in October 29 required cleansing and limewhiting, and in 2 cases the water supply was defective. The sanitary inspections of the sub-district have been carried out in a most systematic and thorough manner by Inspectors Fairchild and Dee, and I can speak very highly of the zeal and intelligence which they have bestowed on their work. ARTHUR NEWSHOLMR, M.D., Medical Officer of Health for Clapham. 23 PUTNEY & ROEHAMPTON. I have the honour to submit the following report of the sanitary condition of the Parish of Putney and Roehampton during the year 1887, and I do so with the greatest satisfaction in as much as the condition of things therein revealed quite maintains the high standard obtained during the last three years. The most prominent fact in the mortality table is the wonderful immunity from zymotic disease which we have enjoyed during a time when London generally suffered severely from epidemics of an infectious nature. No doubt such a result is to a large extent due to the continued and careful sanitary supervision of the district and to the rapid removal to hospital of those cases where isolation cannot be satisfactorily carried out. Population. The population of Putrey in the middle of 1887 is calculated at 15,590. This figure is, I should say, certainly very much below the true one. The increase in the population in this district has made very rapid strides during the last two or three years. Births and Birth-rate. The birth-rate remains about the same as it has been for the last two years. During the year 349 births were registered, which makes the birth 74 rate 22.3 per 1,000. During the last ten years the birthrate in this district has shown a gradual diminution, commencing in the year 1878 with 29.1 per 1,000, and ending at the present year at 22.3 per 1,000. Of the 349 births, 156 were males and 193 females. TABLE I. Birth and Death Rates. YEARS. Births. Birth-rate. Deaths from all Causes. Death-rate Rate of Natural Increase. 1877 1878 338 29.1 186 16.0 13.1 1879 327 27.4 179 15 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 1887 349 22.3 196 12.5 98 Deaths and Death-rate. During the year 196 deaths were registered, of these 97 were males and 99 females. This is equivalent to a death-rate of 12.5 per 1,000. There is therefore a slight increase on the death-rate of the two previous years, but a considerable diminution as compared with the death-rate of the former year of the last decade. The natural increase of the population or the excess of the number of births over deaths was 153, giving the rate of increase at 9.8 per 1,000. Deaths in Outlying Institutions. During the year there were 27 deaths registered of inhabitants of this district who died in outlying institutions. Of these 22 75 died in the Union Infirmary. If these 27 be added to the total number of 196 deaths registered within the district, we get an average death-rate of 14.3 per 1,000. Deaths occurring in Putney and Roehampton. In examining the death record of the year there are several facts which are very apparent and striking. The total number of deaths from zymotic diseases was very low indeed. Only seven deaths from these causes were registered. On the other hand there has been a remarkable increase in the number of deaths due to cancer and nervous diseases. Of the eleven deaths from cancer, seven occurred among females and four among males and eight of the eleven occurred among individuals above 60 years of age. Of the 36 cases of nervous disease the majority occurred among children below 5 years of age, and were chiefly convulsions due to teething and other causes. Ages at Death. Of the total number of deaths 36.7 per cent. occurred among children under 5 years, and 34.1 per cent. among those above 60 years of age. This leaves only the small per centage of 29.2 among all ages between 5 and 60 years. Social Position of Diseases. There were 119 deaths registered of persons classed under the industrial and labouring population, which is equivalent to 60.6 per cent. of the total number of deaths. Among the zymotic class of diseases however, 85 per cent. of the total number of deaths occurred among the working classes. This clearly shows the much greater danger to which the working classes are exposed owing to the conditions of life under which they live, and shows the great necessity of constant sanitary supervision to counteract as much as possible the injurious influence of their surroundings. 76 TABLE II. PUTNEY Total Deaths from each Class of Disease. Sex. Age. Social Position. Population (Census) 1881 18,221 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.   Official Population in middle of 1887 15,590. CAUSES OF DEATH. I. Zymotic. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 2 1 1 .. 2 .. .. .. .. .. .. .. .. .. 2 Diphtheria 1 1 .. .. 1 .. .. .. .. .. .. .. .. .. 1 Scarlet Fever 1 .. 1 .. .. 1 .. .. .. .. .. .. .. .. 1 Whooping Cough 2 1 1 2 .. .. .. .. .. .. .. .. 1 .. 1 Erysipelas 1 .. 1 .. 1 .. .. .. .. .. .. .. .. .. 1 Diarrhoea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery & Cholera. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 7 3 4 2 4 1 .. .. .. .. .. .. 1 .. 6 II. Constitutional. Gout & Rheumatism .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cancer & other Tumours 11 4 7 .. .. .. 1 .. 2 7 1 .. 3 5 3 Tubercular .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Phthisis 20 12 8 2 .. 1 4 9 4 .. .. .. 3 5 12 Tabes Mesa 9 1 1 9 .. .. .. .. .. .. .. .. .. 2 Hydrocephalus 1 1 .. 1 .. .. .. .. .. .... .. .. 1 .. .. 1 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. Nervous 36 16 20 15 8 .. 1 9 2 6 2 .. 7 1 28 ..III. Local. Circulatory 23 12 11 1 .. .. 1 1 9 10 1 .. 4 4 15 Respiratory 34 17 17 5 6 .. .. 2 8 12 2 1 2 12 19 Digestive 20 7 13 11 1 .. .. .. .. 7 1 .. 2 5 13 Urinary 8 4 4 .. .. .. .. 1 1 5 1 .. 4 9 2 Generative .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Locomotory .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. IV. Developmental. Pemature Birth : Atrophy 14 10 4 13 1 .. .. .. .. .. .. .. 1 1 12 Old Age 12 5 7 .. .. .... .. .. .. 8 4 .. 2 3 7 Cause Unown .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. V. Violence 7 4 3 .. .. .. .. 4 3 .. .. .. 1 6 .. Totals 196 97 99 53 19 2 7 19 29 55 12 1 31 45 119 77 TABLE III. Deaths at Outlying Institutions. Sex. Age. Institutions. DISEASE. Total. 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 • • • • • • • • • • • • • • • • V\ hooping-cough • • • • • • • • • • • • • • • • • • Measles • • • • • • • • • • • • • • • • • • Other Zymotic Diseases 1 1 • • • • 1 • • • • 1 • • Tubercular Diseases 1 1 • • • • • • 1 1 • • • • Cancer • • • • • • • • • • • • • • • • • • Rheumatism • • • • • • • • • • • • • • • • • • Respiratory Diseases 8 4 4 • • 3 6 8 • • • • Circulatory Diseases 3 1 2 • • 2 1 2 1 • • Nervous Diseases 9 6 3 • • 8 1 8 • • 1 Other Diseases 4 • • 4 • • 2 2 3 1 • • Violence 1 1 • • • • 1 • • •• 1 • • Totals 27 14 13 • • 17 10 22 4 1 Zymotic Diseases. Table IV. reveals a highly satisfactory condition as regards the prevalence of infectious diseases. We have had no deaths recorded from Small Pox, Enteric Fever, or Epidemic Diarrhoea. Measles and Whooping Cough have each proved fatal in two cases, while from Scarlet Fever and Diphtheria there has only been one fatal case. This death-rate from zymotic diseases altogether was only .44 per 1,000. This very low death-rate is all the more extraordinary considering the prevalence of the Scarlet Fever epidemic throughout the year. It is only, however, right to add that the type of fever during this last epidemic has been 73 of a very mild character. The number of fatal cases therefore was very small relatively to the number of people affected. TABLE IV. Zymotic Mortality in the Putney & Roehampton Sub-district. Zymotic Mortality. 1878 1879 1880 1881 1882 1883 1884 1885 18 6 1887 Small-pox 1 .. .. .. .. .. 1 .. .. .. Measles 7 .. .. 6 13 2 1 4 4 2 Scarlet Fever . . 3 1 8 4 7 .. .. 1 1 Enteric Fever 1 2 4 1 4 2 10 3 1 .. Diphtheria . . . . .. 1 29 24 . 5 1 1 Whooping-cough 4 8 9 3 8 2 8 1 18 2 Epidemic Diarrhæa 10 7 10 3 5 5 8 4 9 .. Other Zymotic Diseases 12 7 1 5 6 2 .. 1 4 1 Total Deaths from Zymotic Diseases 36 27 25 27 69 44 28 18 38 7 Zymotic Death-rate 2.9 2.1 1.3 2.0 5.0 3.1 1.9 1.2 2.49 0.44 Death-ratefor all Disease 16. 0 15.0 13.6 12.5 15.1 17.1 137 11.2 11.8 12.5 Inquests and Uncertified Seven inquests have been held throughout Deaths. the year in this Parish, as seen from the following table. Of these five were due to drowning, which seems to be in this quarter a favourite method of committing or attempting to commit suicide. This of course is doubtless due to the proximity of such a long stretch of the River Thames. Inquests. Natural Causes SPasm of Glottis 1 Natural causes Fracture of Skull 1 Accidental Drowning 1 Accidental Drowning 1 Drowning 1 Suicidal Drowning 1 Drowning 1 Uncertified Deaths. Convulsions 2 Paralysis of Glottis 1 Convulsions and Diarrhoea 1 Epilipsy 1 79 There were also five deaths registered, uncertified by medical men, on which no inquests were held. Sanitary In Table XIV., at the beginning, will be found an interesting summary of the sanitary operations during the year. There were 3,841 houses inspected, compared with 2,277 during the previous year. By the perusal of the table a great amount of most valuable sanitary work will be found to have been carried out. There can be no doubt that the very low death-rate from preventable diseases is to a large extent due to this valuable work being carried on from year to year. First notices have been served to have requisite repairs or alterations carried out in 642 cases, a great increase in the number of last year, when only 268 notices were served. Water closets have been cleansed and repaired in 276 cases In a great many of these cases the water closets were stopped up on account of not being flushed out with proper water supply. This is the usual result of water not being laid on propcrly. In all cases of zymotic diseases after removal to hospital. Disinfection has been carried out immediately on the information reaching the sanitary authorities. In no case has the infectious disease recurred after disinfection has been carried out. The usual sanitary inspections of slaughter-houses, cow-houses, &c., have been made, and in no case was it necessary to oppose a renewal of the license. There have been two new applications for private premises to be used as slaughter-houses, and both have been refused by the Metropolitan Board of Works. It is certainly by no means desirable from a sanitary point of view to 80 crease the number of private slaughter-houses. What is much needed is the erection of a public abattoir for the entire district, to take the place of these private slaughterhouses, which are year by year becoming fewer in number. Wm. Y. ORR, M.B., Medical Officer of Health for Putney and Roehampton. 81 STREATHAM, INCLUDING BALHAM AND TOOTING. I have to announce that the public health in Streatham and Tooting attained a high standard in 1887. The mortality was below that of the previous year. The death rate, exclusive of outlying deaths, was the lowest recorded during the decennium. Inclusive of the latter, it was below the deceunial average. The Zymotic mortality was below that of 1886, and the death rate therefrom was 1.6 per 1,000. There was a marked decline in infant mortality, and a corresponding rise in the deaths from old age. These facts, notwithstanding, the year was not uneventful, as will be shown in detail subsequently, under heading Zymotic Diseases. There were outbreaks of Small Pox and Scarlet Fever, isolated cases of the latter disease occurring in various parts of the sub-district. In all probability it was only unceasing vigilance, and the prompt use of sanitary measures, which protected the threatned district from a wide-spread epidemic. 82 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 prove, I believe, the correctness of my deductions. The afore-named statistics, will also show in detail, many other particulars pertaining to the health of this division of the Wandsworth District. Vital Statistcs. Population. In the ten years before the last census the population incieased from 14,475 to 25,553. Assuming the same rate of increase upon the lastnamed figures, during the seventh year of this decennium we attain a population of 38,225. These figures very nearly coincide with an estimate I made by another method of computation. This method I have fully explained in my last annual report. I believe the figures obtained by these estimates to be as nearly correct as anything can be short of an actual numbering of the people. The population therefore, of Streatham and Tooting in the middle of 1887, was 38,225. Birth and The number of births registered during the Birth-rate. year was 1,185, 623 of males and 562 of females. The birth-rate, calculated from the total number of births and the foregoing estimate of the population was 31.1 per thousand persons living during the year. Natural The rate of natural increase is represented increase, by the excess of births over deaths. This year there was an excess of 739, giving a ratio of 19.1 per 1,000 of the population. 83 Deaths and The total number of deaths registered in Death-rate. 1887 was 445, a decrease of 28 on the number recorded in 1886. Of these deaths 217 were of males and 228 of females. The death-rate, calculated from all the registered deaths, and the foregoing estimate of the population, was 11.6 per thousand persons living during the year. This is the lowest death-rate recorded during the decennium exclusive of outlying deaths. When these are added, the death-rate is raised to 130 per 1,000. 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 31.4 284 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 891 330 341 12.0 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 6 423 139 23 6 1886 1,078 34.3 473 15.0 19. 2 1887 11,85 300 445 11.6 19.1 Deaths in Outlying Institutions. The deaths already tabulated as occurring in this sub-district, do not include those of persons belonging to Streathum 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. 84 DISEASE. Total. Sex. Age. Institutions Male. Female. Under 1 1 to 60. 60 and upwards. Union I0nfirmary General & Special Hospitals. Asylums Board Hospitals. Small-pox .. .. .. .. .. .. .. .. .. Scarlet Fever 3 .. 3 .. 3 .. .. .. 3 Diphtheria .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. Whooping-Cough .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases 3 9 1 1 1 1 1 2 .. Tubercular Disesases 8 4 4 .. 8 .. 1 7 .. Cancer 4 1 3 .. 3 1 1 3 .. Rheumatism 1 1 .. .. 1.. .. 1 .. .. Respiratory Diseases 6 4 9 .. 5 1 2 4 .. Cireulatory Diseases 6 1 5 .. 2 4 5 1 .. Nervous Diseases 8 4 4 .. 4 4 3 5 .. Other Diseases 11 5 6 1 5 5 4 7 .. Voilence 5 2 3 1 3 1 .. 5 .. Totals 55 24 31 3 35 17 18 34 3 There were 55 deaths in outlying institutions, 24 were of males and 31 of females ; 18 took place in the Union , Infirmary, 34 in general and special hospitals, and 3 in hospitals set apart for infectious diseases. When these deaths are added to the 445 deaths, which occurred in the sub-district, the death-rate is raised to 13.0 per 1,000, instead of 11.6, as it is without these outlying deaths. In comparing the death-rate of this and former years, it should be remembered that only during the last 3 years of the decennium have deaths in outlying institutions been included in the local death-rate. 85 STREATHAM, including TOOTING & BALHAM. Total deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. 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, j Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. Population (Census) 1881 Official population in middle of 1887 CAUSES OF DEATH. I. Zymotic. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 21 11 10 3 15 3 .. .. .. .. .. .. 1 6 14 Scarlet Fever 4 1 3 .. 1 1 .. 1 1 .. .. .. 2 1 1 Typhus Ferer 1 1 i 1 Enteric Fever 2 1 1 .. .. .. .. 1 1 .. .. .. 1 .. 1 Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 7 2 5 .. 2 4 1 .. .. .. .. .. 2 1 4 Whooping Cough 6 3 3 4 2 .. .. .. .. .. .. .. 2 1 3 Erysipelas 3 2 1 1 .. .. .. 1 .. 1 .. 1 .. 1 1 Diarrhoea, Dysentery, and Cholera 16 5 11 10 1 .. .. 1 1 3 .. .. 2 6 8 Other Zymotic Diseases 4 1 3 •• 3 .. .. 1 .. .. .. .. 1 1 2 Totals of Zymotic Class 64 26 38 18 24 8 1 6 3 4 .. 1 11 17 35 II. Constitutional. Geut and Rheumatism 6 3 3 .. .. .. .. 3 2 1 .. .. 1 3 2 Cancer other Tumours 21 0 16 .. .. .. .. 1 10 9 1 3 3 7 8 Other Constitutional Diseases 6 2 4 2 .. .. .. 1 1 2 .. 1 .. 1 4 Tubercular Phthisis 36 19 17 1 .. 1 7 18 5 4 .. 2 3 15 16 Tabes Mesa 11 7 4 10 1 .. .. .. .. .. .. 1 • • 3 7 Hydrocephalus 10 5 5 4 6 .. .. .. .. .. .. .. 2 3 5 Scrofula 1 •• 1 .. .. .. .. 1 .. .. .. .. .. 1 .. III. Local. Nervous 60 37 23 23 4 2 1 5 6 17 2 5 12 23 20 Circulatory 35 18 17 1 .. 1 .. 5 11 15 2 7 4 14 10 Respiratory 70 32 38 12 15 2 .. 5 12 22 2 1 13 20 36 Digestive 23 7 10 2 .. .. 1 6 3 9 2 4 5 7 7 Urinary 13 9 4 .. 1 .. 1 2 3 6 .. .. 4 6 3 Generative .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Locomotor .. .. .. .. .. .. .. .. .. .. .. .... .. .. Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. IV. Developmental. Premature Birth and Low Vitality 46 27 19 44 2 .. .. .. .. .. .. 1 8 12 25 Congenital Defects Old Age 31 15 16 .. .. .. .. .. .. 17 14 2 6 11 12 V. Violence 10 5 5 3 4 .. • • 2 1 .. .. .. .. 3 7 VI. Uldefined and Not Specified Illdefined 2 .. 2 .. .. .. .. .. 1 1 .. .. .. 1 1 ot Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 445 217 228 120 57 14 11 55 58 107 23 28 72 147 198 86 Zymotic Diseases— their Prevalence and Fatality. There were 64 deaths in this class, 26 were of males and 38 of females. This yields a per centage of 14.3 upon the deaths from all causes during the year, as against 14.1 per cent last year, and gives a death-rate of 1.6 per 1,000 of the population. Nearly two-thirds of the mortality was due to measles and diarrhoea. The subjoined table contrasts all the deaths resulting from the seven 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 Mortality in the Streatham Tooting Sub-district. 1878 1879 1880 1881 1882 1883 1884 1885 1886 1887 Small-pox 1 .. .. .. .. .. .. .. .. .. Measles 11 2 1 3 5 7 8 2 11 21 Scarlet Fever 2 5 31 13 9 2 8 .. .. 4 Diphtheria 3 2 7 1 4 13 3 5 6 7 Enteric Fever 1 3 5 2 9 8 4 6 3 2 Typhus Fever .. .. .. .. .. .. .. .. .. 1 Whooing-Cough 11 21 8 9 1 11 9 7 23 6 Epidemic Diarrhœa . 13 3 6 9 3 9 11 12 20 16 Other Zymotic Diseases .. 10 10 9 10 15 11 2 1 7 Total deaths from Zymotic Diseases 42 41 68 44 41 65 53 34 67 64 Zymotic Death rate 2.3 2.2 2.7 1.7 1.6 2.3 1.8 1.1 2.1 1.6 Death - rate from all Diseases 16.7 15.6 13. 9 12.1 12.6 14.9 15.3 13.9 15 11.6 On reference to the table, it will be seen that there was no death from Small Pox, nor did any case die in hospital. There was, however, late in the year an break of the disease in Barrow Road. Two children, a boy and girl, were kept at home suffering from Small Pox. These cases were not disclosed to the Authorities till the first attacked was convalescent. Two near neighbours, a Mrs. Corps, who lived two doors off, and a Mrs. Jenner, who lived opposite, were taken seriously ill at the same time, November 24th. The first-named woman was sent to the Small Pox hospital, and ultimately recovered. The last died in a few days from some very virulent disease, certified Typhus. The infected houses were thoroughly fumigated and cleansed, and the disease was arrested. Notwithstanding my efforts to discover the origin of the outbreak, I was unable to do so. At the request of the Streatham Local Committee, I subsequently inspected all the cottages in Barrow Road, (nineteen in number). I found them in a very fairsanitary condition. Turning again to the table we find that there were only four deaths from Scarlet Fever. Though cases were removed to hospital from Streatham and Tooting, this district has not, in comparisor with others, suffered severely from the epidemic which has so generally prevailed in London. Still, it has not been exempt, and more than one outbreak of the disease threatened, at one time, to become wide-spread. One particular case called for prompt action. Its origin was traced to three children in one family who had no medical attendant, and who were allowed to run about whilst actively peeling. When the Inspector of Nuisances became aware of this state of things, he did what he could to put a stop to it, but was too late to prevent infection. 86 On the 10th of October, I was informed that Scarlet Fever had broken out in four or five families of this poor part of West Streatham. I at once visited the locality, saw the medical men in attendance, and invited their co-operation in removal for the future, and in the isolation of those now being treated at home. I also visited the Board Schools, and finding there were very few absentees, concluded the outbreak was limited, I put the teachers on their guard. The Inspector visited the infected houses from time to time and distributed disinfectants. When the children recovered the houses were disinfected and purified in the usual way, and I had the satisfaction of knowing an extension of the disease was prevented by prompt and vigorous sanitary measures. These outbreaks of Small Pox and Scarlatina supply some recent facts in support of notification of infectious diseases. Diphtheria caused seven deaths and Typhoid Fever only two. One death was ascribed to Typhus. All these deaths occurred between May and December, and were widely separated. The premises in every case were carefully inspected for sanitary defects, and the water and milk supply inquired into. It is to be regretted that Diphtheria should be excluded from the Asylums Board Hospitals. Its treatment requires isolation equally with that of other fevers, and its treatment could be better undertaken since operative measures are sometimes called for. Measles was very prevalent during the first half of the year, and caused 21 deaths. It was more fatal than 89 Other Diseases. 1 in any year of the decennium. Probably the long, cold spring had to do with this result, as it favoured pulmonary congestions its generally fatal termination. There were 16 deaths from epidemic Diarrhoea. Allowing for increase of population this did not exceed the average. These are grouped under five heads in the Mortality table, viz :—Constitutional, Local, Developmental, Violence, and Ill-defined. The total number of deaths from the diseases included under these various headings, was below the number recorded in 1886. Considered separately, there was a decline in the number of deaths from some diseases and an increase in others. In the Tubercular Class the mortality was high, forming 13.2 per cent, of all deaths. There was a marked decline in the number of deaths from Respiratory Diseases. They form 15 per cent, of all deaths as against 20.2 per cent, last year. Diseases of the Neivous System resulted in 60 deaths, giving a per centage only of 13.4 upon all deaths. There was a decline in the mortality from Circulatory and Digestive Diseases, and a rise in the deaths from Old Age and Violence. The deaths from the other diseases under the various headings do not differ sufficiently from their averages to call for special remark. 90 Ago at death InfantMortality. There Was a marked decline in the deaths of infants under one year of age. The numbers fell from 144 last year to 120 this year, being only 26.9 per cent of all deaths as compared with 30.4 per cent in I886. 12.8 per cent of all deaths took place before the age of live, and upward of 45 per cent before the age of twenty. Semile Mortality. There was an increase in the mortality from tubercular diseases in early life, and a decrease in that due to nervous, digestive and respiratory diseases. Thirty-one deaths are ascribed to old age, as compared with 21 in the previous year; 15 were of males, and 16 of females. 130 deaths took place at, and over 60, the ages of 54 of these ranged from 70 to 80, and 23 from 80 to 90, two were respectively 90 and 91. Senile deaths yield a Percentage of 26 on all deaths. Of the persons who died at 70 and upwards, 34 were males, and 45 females. Sickness and Mortality amongst the out-door Parish Poor. The number of persons who were under treatment, together with the nature and extent of the sickness that prevailed, and the deaths that took place amongst the out-door parish poor will be found in Table 13. 395 cases came under treatment during the year. 81 of these were in the Zymotic class. They include one case of Small-pox, 30 Measles, 17 Scarlet Fever, 10 of Whooping Cough, 20 of Diarrhoea, one of Enteric Fever, and two of Puerperal Fever, with three deaths one each from Measles, Whooping Cough and Diarrhoea. The fever cases were sent into Hospital. There were sixteen deaths in the other classes due principally to old ago, low vitality and lung affections. 91 Social Position- The following Table shows the percentage of deaths in the various classes during the year. Nobility and Gentrv 28 = 6.29 per cent. Professional Class, Merchants, &c. 72 = 16.2 ,, Middle and Trading Class 147 =33.01 ,, Industrial and Labouring Class 198 = 44 5 ,, Total deaths 445 100 There was a lower rate of mortality in all classes during the year, more markedly so in the Higher, Middle, and Industrial than in the Professional Classes Seventeen inquests were held with the allowing results:— Inquests Violent Deaths. I. Natural .. Natural causes 1 Syncope 4 Convulsions 3—8 II. Accidental Scalds 1 Poisoning 1 Asphyxia by drowning 1 Suffocation 1 Fracture of Skull 3 Run over by van 1 Bun over by train 1—9 Uncertified Deaths. 17 Six deaths were uncertified, they were all submitted to the Coroner before being registered as having probably died from the following causes:— Heart Disease Natural Decay 1 Measles Bronchitis 1 Convulsions 1 Syncope 1 Exhaustion 1 6 Sanitary Proceedings. A summary of the usual and principal sanitary works of the year may be seen in Table 14. This does not include a large amount of work which cannot be tabulate. 92 The figures chow that there has been no fallirg-off in the inspection of houses. No less than 3,841 houses were inspected, and their sanitary condition recorded. 445 first notices were served to remedy defects and abate nuisances. Only 17 second notices were needed to ensure compliance, and a large amount of sanitary improvement was effected on requisition. It was not found necessary to apply to a magistrate in any case. Amongst the more important works of the year may be mentioned the lifting, altering, and relaying of imperfect drains, and the cleansing of foul drains. Also the syphoning off of sewer gasses, altering sinks, baths, lavatories, and rain-water pipes to discharge over gullies outside. Also cleansing and repairing of water closets, causing water to be laid on 18 closets, providing dust bins and cisterns, and repairing and covering a large number of the latter. The higher figures in respect of these improvements are shown in the table. In addition to this, 13 pig nuisances were removed, and 87 accumulations of manure were got rid of, 70 unwholesome and dilapidated houses were repaired and cleansed, and 30 cesspools abolished. There were 76 rooms in 53 houses disinfected after infectious diseases as compared with 23 last year, 51 after Scarlet Fever, 2 after Typlioid, 6 after Diphtheria, 5 after Small-pox, there was no recurrence after disinfection. The Inspector carries out my instructions regarding these matters, to my entire satisfaction. The bake-houses have all been regularly inspected, and are in good condition. I personally inspected all the cow-sheds and slaughter houses, and saw no reason to oppose a renewal of the owners' licenses. 93 I was also instructed to make the following special reports:— I. The ssiate of Larch Bead.—This ioad is not a parish road, and when I inspected it. had the appearance and characteristics of undedicated roads generally, was in a rough state and badly kept, though not in itself unhealthy. In the adjoining ground on the north side and close to the end of a terrace of houses, there was a shallow pond of stagnant water, and on the ground adjacent some loads of house-refuse. As a sanitary precaution the water was drained off, and further deposit of houserefuse prevented. II.—On the 7th of June I inspected with Mr. Barber, the Surveyor, the site of Mr. James Curtis' proposed catgut factory at Field View, Totterdown, Tooting. Having regard to its position within fifty yards of the High Street, Tooting. its proximity to a number of small houses and some workshops, I thought it undesirable to establish such a business, so liable to become a nuisance, in such a neighbourhood, and reported accordingly. The Board consequently objected to the proposed factory. I attended the Metropolitan Board of Works when the case came on for hearing. The application was refused. III. Condition of Cottages in Barrow Road.—In consequence of the outbreak of Small-pox in October, and to determine their fitness for human habitation, I inspected these cottages. There was no nuisance in any of them, and in four only slight defects in water supply apparatus. The houses were in a very fair sanitary condition, and quite fit for human habitation. 94 I have to thank Mr. Barber, the Surveyor, for his ready assistance in all matters relating to the sanitary state of the district. His long experience and ripe judgment render his co- operation very valuable. Mr. Phimister, the Inspector of Nuisances, is a very active and zealous officer. He carries out his onerous and responsible duties in a very efficient manner. Mr. Jones, the Assistant Inspector, performs his duties in a very satisfactory manner. F. F. SUTTON, M.D., Medical Officer of Health for Streatham and Tooting. 95 WANDSWORTH. The health of this sub-district during the year 1887 was in a very satisfactory condition. The total mortality was unusually low, and the amount and fatality of epidemic disease with its attendant loss of infant life were greatly reduced. The only zymotic diseases which prevailed epidemically were Measles and Diarrhoea, and there was, with slight exception, immunity from the epidemic of Scarlet-fever from which the Metropolis generally suffered to so great an extent. The prevalence of a low death-rate with a high birth-rate and a low rate of infant mortality which, with other detailed statistics, will be found recorded in the following pages, may be accepted as trustworthy exponents of the high vital status of the inhabitants of this rapidly-increasing suburb during the past year. Vital Statistics. Population. Assuming that the population has increased during the past year in the same proportion as it had done during the ten years preceding the last census, the mean number of inhabitants during 1887 amounted to 33,141. 96 Ttirths—Birth-rate—Rate of Natural Increase. The total number of births registered during the past year was 1,338—673 of males, 665 of females. This number, which is greater by 83 than that of the previous year, exceeded the average number of the preceding ten years, allowing for increase of population, by 264. This excess is 24½ per cent., and very pointedly indicates a large accession to the population by immigration. Calculated from the total births registered and the foregoing estimate of the population, the birth-rate of the past year was 41.96 per 1,000, and the rate of natural increase 24.59 per 1,000 persons living. Mortality. The total number of deaths registered during the year was 610—295 of males and 315 of females, and is less by 112 than that of the year previous, and by 8 than the average of the preceding ten years, raised for increase of population. 127 of all deaths occurred in the following institutions, viz:—in the County Lunatic asylum 95; in the Hospital for Incurables 9; in St. Peter's Hospital 3; in the Prison 13; in the Workhouse 6; and in the Royal Patriotic Asylum for Girls 1. In addition to the foregoing deaths recorded within the sub-district, 67 deaths of Wandsworth parishioners were registered as having occurred in the following outlying institutions, viz:—in the Infirmary of the Union 44, and in the Metropolitan hospitals 25; these with the sex, age, and cause of death of the deceased, are exhibited in the following table :— 97 Deaths in 0ullying 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 5 5 .. .. 5 .. .. .. 5 Diphtheria ..... .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. Enteric Fever 1 1 .. .. .. .. . . 1 Diarrhoea .. .. .. .. .. .. .. .. .. Other Zymotic Diseases. 1 .. 1 .. .. 1 1 .. .. Total Zymotc Diseases 7 6 1 .. 6 1 1 .. 6 Tubercular Diseases 15 13 2 .. 13 2 12 3 .. Cancer 1 1 .. .. .. 1 1 .. .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 8 3 5 1 3 4 8 .. .. Circulatory Diseases 7 2 5 .. 4 3 6 1 .. Nervous Diseases 5 1 4 1 3 1 4 1 .. Other Diseases 24 12 12 4 11 9 12 12 .. Violence 2 2 .. .. 1 1 .. 2 .. Total 69 40 29 6 41 22 44 19 6 Death-rate. Determined from the total deaths registered and the official estimate of the population, the death-rate of the past year was 16.59 per 1,000 persons living. In this calculation, correction is made for the deaths that occurred in the Surrey County Lunatic Asylum, St Peter's Hospital, and the Hospital for Incurables, the inmates of which institutions are derived almost entirely 98 from without the parish, undergo no natural increase, and arc subject to a high mortality, the latter averaging about one-fifth of all deaths registered—an amount which, without such correction, would simply reflect the fluctuations of the mortality of these institutions, and render the death register useless as a datum for deducing the natural death-rate of the sub-district. On the other hand the deaths of Wandsworth parishioners that occur in the Union Infirmary are registered in Battersea, in which sub-district that institution is situated. The correction referred to consists in withdrawing from the calculation the population and mortality of the Asylum and above-named hospitals, and adding to it the deaths of Wandsworth parishioners that occurred in the Union Infirmary. Inclusive of the deaths that took place in uublic hospitals and other institutions external to the sub-district (and which may be fairly assumed to be equalled by the deaths of non-parishioners within the sub-district), the death-rate was 17.37 per 1,000, or .37 per 1,000 only above the healthiest of the rural districts. The birth and death-rates here given have been determined from the foregoing estimate of the population according to the official method, but looking to the remarkably large number of births in excess of the decenial average and the great increase in the number of inhabitants as shewn by the parochial rate-book, there can be but little doubt that the population thus estimated is very much below the actual number, a result which it need be scarcely observed, has the effect of unduly raising the birth and death-rates. The assumption that 99 such is the case finds corroboration in the proportion which the annual average number of births bore to the annual average number of persons living during the preceding ten years. Calculated from this proportion the mean population of 1887 was 35,144, giving a birth-rate of 38.07, a death-rate of 15.76, and a rate of natural increase of 22.31 per 1,000. The Birth and Death rates for the past and ten preceding years are shewn in the subjoined table. Birth and Death Rates. Team. Births. Birth- rate. *Deaths from all causes. Death-rate. Rate of Natural Increase. Corrected. Uncorrected. 1877 684 29.90 384 12.59 16.13 17.31 1878 718 30.53 422 14.41 17.26 16.12 1879 744 37.97 516 18.04 20.56 19.93 1880 810 30.53 484 15.45 17.67 15.08 1881 901 33.70 507 17.43 17.97 16.61 1882 972 35.28 544 17.49 18.70 17.79 1883 907 32.07 499 16.17 16.71 15.90 1884 1,072 36.72 576 17.23 18.77 18-84 1885 1,122 37.37 628 18. 82 19.93 18.55 1886 1,255 40. 40 722 19.05 22.33 21.35 1887 1,338 41.96 610 15.58 18.40 24.59 * Deaths in Outlying Institutions not included. The following table exhibits all the causes of death classified according to the sex, age and social position of the deceased persons, the diseases of the zymotic class being severally set forth :— 100 STATISTICS OF MORTALITY. WANDSWORTH. Population (Census) 1881 28,004 Official Population in middle of 1887 33,141 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. Mobility and Gentry. Professional Class Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. CAUSES OF DEATH. I. Zymotic. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 20 9 1 11 5 14 1 .. .. .. .. .. .. 1 2 l7 Scarlet Fever .. .. 1 .. .. .. .. .. .. .. .. .. 1 Typhus Fever 6 2 4 .. .. 1 1 3 1 .. .. .. .. 2 4 Enteric Fever Puerperal Fever 2 .. 2 .. .. .. .. 2 .. .. .. .. .. .. 2 Diphtheria 2 2 .. 1 .. 1 .. .. .. .. .. .. .. .. 2 Whooping-Cough 8 3 5 4 4 .. .. .. .. .. .. .. 1 1 6 Erysipelas 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 Diarrhoea, Dysentery, and Cholera 30 15 15 23 4 .. 1 .. 2 .. .. .. 1 9 20 Other Zymotic Diseases 1 1 .. .. .. .. .. 1 .. .. .. .. 1 • • •• Totals of Zymotic Class 71 33 38 34 23 3 2 6 3 .. .. .. 4 14 55 II. Constitutional. Gout, and Rheumatism 11 6 5 .. .. 2 1 3 1 4 .. 1 3 3 4 Cancer & other Tumours 16 6 10 .. .. 1 .. 2 6 7 .. 3 .. 4 9 Other Constitutional Diseases 5 3 2 2 1 .. .. .. 1 1 .. .. .. 2 3 Tubercular - Phthisis 70 34 45 .. 5 1 11 30 26 6 .. .. 4 24 51 Tabes Mesenterica.. 30 16 14 24 4 1 .. 1 .. .. .. .. 1 5 24 Hydrocephalus 1 1 .. .. 1 .. .. .. .. .. .. .. .. 1 .. Sciofula 1 .. 1 .. .. .. .. .. 1 .. .. .. .. 1 .. III. Local. Nervous 115 62 53 23 11 3 1 13 33 27 4 7 5 40 63 Circulatory 32 16 16 1 2 .. .. 5 10 13 1 2 3 3 24 Respiratory 110 56 54 27 21 4 2 5 19 28 4 2 5 24 79 Digestive 30 11 19 3 .. .. 1 5 12 9 .. 3 2 9 16 Urinary 17 13 4 .. 3 .. 1 3 5 5 .. .. 3 5 9 Generative 2 .. 2 .. .. .. .. 2, .. .. .. .. .. 1 .. 1 Locomotory 1 .. 1 .. .. .. .. .. 1 .. .. .. .. 1 Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• IV. Developmental. Premature Birth, Low Vitality, and Congenital Defects 38 18 20 37 .. 1 .. .. .. .. .. .. 2 13 23 Old Age 36 15 5 2l .. .. .. .. .. .. 15 21 .. 3 3 13 17 V. Violence 13 8 2 1 1 1 2 3 3 .. 1 4 8 VI. Ill-defined and Ill-defined. Not specified Not specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 2 .. .. .. .. 1 1 .. .. .. .. .. 2 Totals 610 295 315 153 72 17 20 78 122 118 30 21 36 166 387 101 Causes of Death. The following are the numerical proportions borne by the several classes of disease in the causation of the mortality recorded in the foregoing table. The highest number is seen to be attained by diseases of the brain and nervous system, amounting to 115; this number is 24 less than the average, the diminution being principally due to a decrease in the number of deaths in the Surrey County Lunatic Asylum, but as this class is unduly raised by the deaths in that institution, the proportion due to the sub district proper cannot be accurately determined. Exclusive of this class, the first in order of fatality was the Tubercular class contributing 111 deaths, or 32 above the average. Inclusive of other constitutional diseases formerly classed as "Gout, Rheumatism, Cancer, and of uncertain seat," the number is 143, or 42 above the average; 79 deaths in this class were due to Consumption alone, the latter being as usual the most fatal single disease. The next most fatal class was "Diseases of the Respiratory Organs," which amounted to one less only than the number of the preceding class, and were 6 above the average, Bronchitis, which caused 53 deaths, being the most fatal of the class. The Zymotic class contributed 71 deaths only being 30 less than the average. The deaths from "Premature birth, Low Vitality, Congenital defects, &c.," numbered 38 and were 4 above the average. The next in amount were from Age, 36, or 5 above the average. Diseases of the "Heart and Circulation" cause 32 deaths, or 2 above the average; "Diseases of the Digestive Organs" 30, being 2 below the average; Diseases of the Urinary Organs, 17, or 3 above the average; and Violence, 13, being 6 below the average. The remaining classes present no deviation from their average amounts which requires notice. The most noteworthy records in the table are the increase in the falality from diseases of the Tubercular class and dis- 102 eases of the Respiratory Organs, but more satisfactorily, the great diminution in the number of deaths from diseases of the Zymotic class. The variation in the numbers of the different causes of death are compared with their corresponding numbers in the preceding ten years, and with their respective averages in the two following tables, the former comprising the mortality of the non-zymotic and the latter that of the zymotic class of diseases. Non-zymotic Mortality.—Table shewing the number of deaths in 11 years, 1877—87, with the increase or aecrease of deaths in 1887, compared with the annual average deaths in 1877—86 raised in proportion to increase of population. Causes of Death. 1877. 1878. 1879. 1880. 1881. 1882. 1883. 1884. 1885. 1886. 1887. No. above corrected aveiage. No. below 1887 corrected average. Developmental. Local. Constitutional. Tubercular 54 60 62 60 51 69 64 85 90 87 111 32 Other Constitu- tional 17 14 12 17 19 19 20 18 28 30 32 10 Nervous 111 111 96 106 121 106 116 128 145 151 115 24 Circulatory 21 19 20 23 28 28 25 22 36 46 32 2 Respiratory 42 86 125 89 90 87 69 70 101 135 110 6 Digestive 18 29 21 21 28 28 35 47 22 30 30 2 Urinary 9 4 10 11 4 20 13 15 12 26 17 3 Generative 3 4 10 1 4 3 6 4 2 1.5 Locomotory 1 3 2 1 2 2 1 Integumentary 1 3 5 Premature Birth Malformation 19 18 18 27 37 27 23 40 37 45 38 4 Low Vitality Age 13 14 26 23 27 27 33 42 34 32 36 5 Violence 11 13 11 11 20 18 32 21 15 17 13 6 Ill-defined or 3 1 1 4 1 3 2 Notspecified 3 1 1 4 1 3 2 5 103 Zjmotic Mortality. Epidemic Diseases, their prevalence and fatality. The following table exhibits the total deaths that occurred from Zymotic diseases, 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 1887 compared with the annual average deaths in 1877-86, raised in proportion to increase of population :— Diseases. 1877 1878 1879 1880 1881 18S2 1883 1884 1885 1886 1887 No. above corrected _ average, cc No. below corrected • aerage. Seven principal Epidemic Diseases. Small Pox 19 1 3 .. j 1*6 Measles.. 4 16 9 5 18 14 6 19 28 20 6 .. S' arlet Fever21 2 15 24 19 9 5 5 3 6 1 11 Diphtheria. 4 1 4 1 311 4 6 10 2.. 3 II Enteric I 938649 12 448 6.. 1 Whooping Cough11 6 44 15 12 26 5 17 24 31 8 14 Diarrhoea i 16 19 7 20 19 29 10 27 35 28 30 6 .. Cholera f Total Deaths from above Epidemic Diseases.. 57 38 92 78 69 94 57 64 94 111 67 21 Other Zymotic Diseases 6 10 12 14 7 14 20 19 3 5 4 8 Total I)< alhsfrom ZymoticDiscases 63 48 104 92 76 108 77 83 97 116 71 30 Zymotic Death- rate per 1,0U0 . 2 64 1 96 4 14 3 35 2 71 372 2\57 2*70 3 07 3*58 2 14 1*42 Total Deaths from allcauses ,.;584 422 516 484 507 544 499 576 628 722 610 8 Per centage of Deaths from Epidemics to Deaths from all causes 14*8 9'0 17'8 161 13*6 17 2 111*4 11 1 14*9 15*3 10 9 5 6 I 104 The total deaths that occurred from the above diseases during the past year are seen, on reference to the table, to have been 71; this number is 41 less than that of the previous year, and 30, or nearly one-fourth part less than the decennial average. 67 belonged to the Epidemic class: the deaths from each disease of this class are seen to have been below the average, with the exception of Measles and Diarrhoea, from both of which they exceeded the average number by 6. Measles prevailed to a considerable extent during the first eight months of the year, but mostly in the Summer and early Autumn, when Diarrhoea was also most prevalent. The deaths from these two diseases occurred almost entiiely to children under five years of age, and in the case of the latter disease, with four exceptions, exclusively to infants under one year of age. Whooping-Cough resulted in 8 deaths, being 14 less than the average. Enteric Fever, in 6 deaths, or 1 below the average; and Scarlet Fever in 1 only, but 5 occurred in the Asylum Board's hospitals. Inclusive of these the number is 5 less than the average. Small-pox, as in the previous year, was entirely absent, in reference to which the following extract from the Return of Vaccination made by the Vaccination Officer to the Local Government Buard may be here fitly introduced. Vaccination. Respecting the vaccination of children whose births occurred in 1886, it appears from such return that of the 1,260 children born, 1,042 were successfully vaccinated, 120 died unvaccinated, 21 were postponed on account of sickness, 5 were certified as "insusceptible," and 2 removed to places duly notified, leaving 70 or 5.5 per cent. who had removed to places unknown or out of reach. The following table shews the months in which the deaths from epidemic diseases occnrred, with the mean temperature of each quarter. The great majority of these deaths is seen to have 105 resulted in the third quarter, and to have much exceeded the combined number of the other three quarters, the excess having been principally due to Diarrhoea, the result of the high temperature of the period. DISEASE. January February March April May June July August September October November December Mean Temp. Mean Temp. Mean Temp. Mean Temp. 37.3 51.6 61.0 41.3 Small Pox Measles 1 2 4 5 7 1 Scarlatina 1 Diphtheria 1 1 Whooping Cough 2 1 1 1 3 Diarrhoea 1 13 11 1 3 1 Fever 1 1 1 1 1 1 Totals 3 3 4 2 4 6 21 13 2 1 4 4 10 12 36 9 Deaths in relation to Social position. The proportion per cent. of the total deaths, as well as of those from zymotic diseases in relation to the social position of the deceased, is shewn in the subjoined table:— Social Position. Total Deaths. Deaths from Zymotic Diseases. 1887. Decennial Average. 1887. Decennial Average. Nobility and Gentry 3.44 3.41 0 00 1.27 Professional lass, Merchants, Bankers, &e 5 90 4.81 5.63 4 22 Middle & Trading Classe Clerks, &c 27.22 22 78 19.92 20 08 Industrial and Labouring Classes 63 44 69.00 74.45 74.43 100.00 100.00 100.00 100.00 110 The mortality from zymotic disease sustained by the labouring population in comparison with that of the other classes combined is seen to have corresponded with the average amount, but the proportional amount of the total mortality that occurred amongst the labouring classes underwent the unusually large reduction of more than 5½ per cent. during the past year, a circumstance which furnishes a marked indication of sanitary progress in the direction of its greatest requirement. Infant Mortality. As might be anticipated from the diminished fatality during the past year of epidemic diseases, the most destructive of infant life, a very considerable reduction is noticeable in the amount of infant mortality; thus the proportional number of deaths of infants under one year of age in relation to the number of births was 11.4 per cent., the decennial average being 13.6 per cent. Relatively to the total mortality however, infrnts under one year of age suffered a disproportionately greater number of deaths, as is seen on comparing the annual number with the decennial average number of deaths of children at the following ages, viz:—the deaths of children under ten years of age formed 39.6 per cent. of the total mortality, the average being 40.8 per cent., whereas the deaths of infants under one year formed 25 per cent. of all deaths, the average being 21.8 per cent. The relatively greater mortality of infants under one year was the result of the fatality of Diarrhoea having been, as already shown, almost exclusively borne by them. Senile Mortality. Eighty deaths occurred at 70 years and upwards, the average number being 62, and of the former 36 were registered as due to old age, unassociated with disease. The sex and age of the deceased with the numbers at different periods are set forth in the following 107 tabular form. The females are seen to be one third more numerous than the males, and, as usual, to exceed them in longevity, the highest age attained, that of a female, being 96 years. Age. Males. Females. Total. 70 — 75 8 13 21 75 — 80 16 16 32 80 — 85 5 12 17 85 — 90 3 5 8 93 1 1 96 1 1 32 48 80 Sickness and Mortality of the Parochial Poor. The several diseases with their nature, amount and fatality, that occurred amongst the parochial poor during the year are contained in Table XIII., page 21. The total number of fresh cases coming under treatment was 683 and the total number of resultant deaths 31, or 4.5 per cent., being somewhat below the average. The largest proportion of the mortality was contributed by diseases of the breathing organs, amounting to nearly one-third of the whole, 207 cases having resulted in 10 deaths. Epidemic diseases were greatly diminished in number and intensity; they amounted to 49, the average number being 88. As in the sub-district generally, the only diseases that prevailed epidemically were Measles and Diarrhoea, 15 cases of the former and 25 of the latter. There were 5 cases of Fever, 2 of Scarlatina, and I of Diphtheria. They were all unattended with fatality 108 except Measles, from which two deaths resulted. The figures in the table are valuable as furnishing corroboration of the indications of the health of the sub-district derivable from the Statistics of Mortality on page 100. The latter show the results of disease in one direction only—that of fatality—whereas the former present the favourable as well as fatal results of a given amount of sickness, and thus furnish an index of the intensity of disease that has prevailed generally. Thus the great prevalence and fatality of diseases of the Respiratory Organs and the great diminution in the amount and intensity of epidemic diseases are prominently evidenced by the figures contained in the table above referred to. Inquests, Violent Deaths, Uncertified Deaths. Fifty inquests were held during the year, being 6 more than in 1886. In 36 instances verdicts of death from natural causes were returned, and in 13 from violence, or 5 less in number than in the year preceding. 12 of the violent deaths were accidental and 1 suicidal. In one instance the cause of death was not specified. In 6 cases only was the cause of death uncertified by medical testimony, and each of these was submitted to the Coroner, who, after investigation of the circumstances attending the death, considered further inquiry unnecessary. The following is a tabulated statement of the number and sex of the persons who formed the subjects of the inquests, with the verdicts of the latter;— 109 Males. Females. Total. Deaths from natural causes 29 7 36 Deaths from violence, viz:— Concussion of Brain from a Fall 1 Scalds and Burns 1 1 Drowning 1 1 Accidental Fractures 1 2 Suffocation 1 2 Choked by a Piece of Cheese 1 - Suicidal Poisoned by Swallowing Carbolic Acid - 1 1 Not specified Found Dead in Thames — 1 1 34 16 50 Sanitation. The sanitary proceedings of the year are enumerated, as far as is practicable, in Table XIV. page 23, on reference to which it will be seen that a vast amount of work, as represented by the inspection of houses with the remedying their defects and the removal of nuisances generally, has been accomplished. 4,449 houses were inspected, the number being 254 more than in the year preceding. 740 notices were served to remedy defects, or 215 more, while the second notices required to be issued were 60, or 33 less than in 1886, which would seem to indicate a greater readiness on the part of owners and occupiers of houses to comply with the requirements of the sanitary law than heretofore. Irrespective of the greatly increased numbers in the table arising out of the building of new houses, as in the instance of new drains, water supply, &c., the figures relating to important details are much higher than in 1886. The disinfection and purification of houses in which infective diseases occurred were vigorously 110 secuted. In most instances sulphur-fumigation was the agent employed, and, as in the year preceding, without the recurrence of the disease for the prevention of which its use was required, and to this preventive measure with early removal of the patient to hospital, much of the immunity of this sub-district from epidemic disease during the year is without doubt attributable. The cow-houses, 16 in number, and the slaughterhouses, 8 in number, were examined and their condition reported on prior to a renewal of their owners' licenses. The bake-houses, 37 in number, also underwent, as usual, periodical inspection. They were all in a satisfactory condition. The whole sanitary procedure was conducted without the intervention of the law except in two instances, in which it became necessary to obtain prohibitory orders from the sitting magistrate for the suppression of a piggery in the centre of the town in one instance, and for the prevention of the deposit of house-refuse and other noxious matters on the Osier grounds, Riverside, in the other. The statistical and other data presented in this Report collectively furnish conclusive evidence of the attainment by this sub-district of a high standard of health during the past year, and the extensive amount of important sanitary work above referred to may be justly accepted as having conduced to such a satisfactory result. In conclusion I beg to bear testimony to the zealous manner in which the Sanitary Inspectors have performed their important duties. GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsworth. 111 ANALYSTS REPORT. South London Central Public Laboratory, 325, Kennington Road, S.E. London. March 6th, 1888. To the Wandsworth District Board of Works. Gentlemen, In accordance with the usual custom, I beg to report that during the year 1887, I received from the Inspector and duly examined 428 samples of food aud drugs, and 11 samples of water. Of these, the following articles of food were fonnd to have fallen below the legal standards:— 6 Samples of Milk (having from 11 to 25 per cent. of Water ) 11 ,, Butter ( ,, 50 to 100 „ Animal Fat) 3 „ Pepper ( „ 8 to 15 „ Spent Ginger.) 3 ,, Coffee ( ,, 23 to 35 „ Chicory). Total 23 Samples condemned, or 5½ per cent. Nearly all the samples of water were found to be more or less contaminated, and live were absolutely condemned. 112 A special investigation into the state of the water and mud in the Lake at Battersea Park exhibited a most unsatisfactory state of things, and pointed to the urgent necessity of cleansing the same. Between the date to which the above returns are made up and the present time, the Margarine Act has become law. It is too early yet to speak with confidence, but it has at all events started well, and the tradesmen of the district are honestly carrying it out so far, by duly stamping all parcels of suspicious butter. I have the honor to be, Gentlemen, Your obedient Servant, JOHN MUTER, Ph. D., F.R.S.E., F.I.C. Public Analyst. THE BOARD OF WORKS FOR THE WANDSWORTH DISTRICT. ANSWERS TO QUESTIONS ADDRESSED BY THE MEDICAL OFFICERS OF HEALTH FOR THE WANDSWORTH DISTRICT TO THE MEDICAL OFFICERS OF HEALTH OF THE UNDERMENTIONED TOWNS. What plan of Notification is in force in your town ? Do you regard yours as the best system of Notification ; or what other plan would you prefer ? Does the plan work without friction with Householders or Medical Practitioners ? Have many cases occnrred in which legal penalties require to be enforced against persons refusing to notify ? REMARKS. a. Compulsory on Practitioner in attendance. b. Compulsory on Householders. c. Compulsory on both. ABERDEEN (Dr. Thomson). Yes * • No; I should prefer compulsory on both There is occasional friction No cases We have had no trouble with the medical practitioners except in so far as they complain to me that their patients threaten to leave them it they notify infectious disease to us. I have not, however, had a case of a medical practitioner reiusing to notify or wilfully neglecting to do so. I should prefer the householder to have to notiry jointly with the practitioner, because then the householder will reaise better than he does at present that his doctor must report the case. His having to do so would, I think, make the task easier for his doctor and remove from the weaker or more needy members of the profession the temptation (no doubt often a strong one) to conceal the case ACCRINGTON (Dk T. Milne, M.O.H.) On both Yes So far there has not been the slightest friction No case of refusal to notify has come to the knowledge of the authority ASHTON-UNDER-LYNE. (Dr. Hughes). Compulsory on practitioner, Fee 2/6 per case paid. consider this plan works well enough It does, certainly None BARROW-in-FURNESS (Dr. Settle). On both . Yes Householders never report where a medical man is in attendance, but there has been no attempt to evade the Act None BIRKENHEAD (Dr. Vacuer). On both Yes Yes The L.A. has never prosecuted anyone BLACKBURN (Dr. Stephenson) On both Our system is very good Not quite Only one BLACKPOOL (Dr. Welch) On both Our plan works smoothly— chiefly, I believe, because 1 am not engaged in general practice. My predecessor, who was in practice, had some difficulty occasionally. Practically I receive the notification from the medical man only " * For the last 5 years I have only had some 6 cases notified by householder, nevertheless 1 think it right that some responsibility should be thrown upon the householder who in fact is morally the only person who owes this duty to the State BOLTON (Dr. Serjeant). On both The medical practitioner, except in a very few cases, takes the responsibility of reporting, and further notification from the householder is rendered unnecessary BRADFORD (Dr. Hime). Compulsory on practitioner lo notify to parent Ou householder to notify directly if no doctor, and if there is a doctor, to forward his notification On both Yes Yes, entirely so Not one [ think our method much the best, and it is most acceptable to medical men. They feel that they are only notifying to the parents; but as a matter of practice, 99 per cent. of the forms are posted to me direct by the doctors, who do this to oblige and save delay by the neglect of ignorant parents. Everything depends ou the tact and good repute of the M.O.U., and ou his not being in practice BURNLEY. (Dr. Dean). Yes. Yes Not both, but either Yes Yes None BURTON-ON-TRENT (Dr. Perks). Compulsory on both practitioners and householders, but we only enforce the former Yes Yes, practically Not one , CHADDERTON (Dr. Patterson). Ou both Yes No trouble with the doctors the cottagers are ignorant of the law and don't report. We intend to circulate a handsome almanack containing information on this point I am not aware that any person of knowledge has refused to notify 2 What plan of Notification is m force in your town? Do you regard yours as the best system of Notification; or what other plan would you prefer ? Does the plan work without friction with Householders or Medical Practitioners ? Have many cases occurred in which legal penalties require to be enforced against persons refusing to notify ? REMARKS. a. Compulsory on Practitioner in attendance. 1 b. Compulsory on Householders. c. Compulsory on both. CHESTER (Dr. Kenyon), On both Yes Yes None Notification clauses have been in operation since the beginning of the year. Practically the clauses against householders operate only indirectly, the medical men almost exclusively reporting CROYDON (Dr. Philpot). On both Yes Yes No; difficulty in getting evidence such as would convict has prevented our taking proceedings against the only medical man who refuses to notify DERBY (Dr. Iliffe). On both Certainly; no other plan can possibly be successful Yes Twice in 9 years DEWSBURY (Dr. Watts). Compulsory on practitioner Yes Yes No DUNDEE (Dr. Anderson). On both Yes Yes None EDINBURGH (Dr. Littlejohn). Compulsory on practitioner I decidedly, after 9 years' experience, think our plan the best Yes, householders are pleased with it, especially hotelkeepers and lodging-house keepers; medical men equally so None GREENOCK (Dr. Wallace). No Yes No Would prefer compulsory notification on both medical practitioner and householder At first there was some friction, but by moral suasion and knowledge of favourable results, this has been gradually and almost entirely overcome Comparatively few, moral suasions having become in most cases successful GUILDFORD (Dr. Morton). On both The best Yes No; but warning has been given HALIFAX (Dr. Ainley). On both We consider it very good Yes None Of course the householder never notifies when a doctor is attending; if no doctor is called in, then he does HARTLEPOOL (Dr. Morison). Compulsory on practitioner Yes Yes None HUDDERSFIELD (Dr. Carnham). On both Yes, on the whole Fairly so Not many JARROW (Dr. Munro). On both Yes No friction except with one medical practitioner, who only notifies the existence of cases, leaving the M.O.H. to diagnose them Only in the case of this one practitioner LANCASTER (Dr. Parker) On both Ye? Yes None LEEK (Dr. Ritchie). Voluntary notification by all medical men sent to sanitary inspector, not to M O. H.; fee 2/6, paid by the Sanitary Authority It answers admirably; no medical man objects Yes None LEICESTER (Dr. Tonkins). On both The dual notification has worked well for 8 years Yes None. A few cases have been threatened, where the friends of children suffering from scarlet fever have had no doctor in attendance and have simply neglected to report LLANDUDNO (DR. Rees) On both I believe it to be at least as good as any other Yes No Llandudno being a watering place, the medical practitioners are keenly alive, from past experience, to the danger of infectious diseases, especially during the bathing season, and they notify with the utmost promptitude and willingness—so much so, that the clause compelling notification by householders has been allowed to become a dead letter. I am, however, of opinion that in other towns the co-operation of householders would be of great service 3 What plan of Notification is in force in your town? Do you regard yours as the best system of Notification; or what other plan would you prefer ? Does your plan work without friction with Householders or Medical Practitioners ? Have many cases occurred in which legal penalties require to be enforced against persons refusing to notify ? REMARKS. a. Compulsory on Practitioner in attendance. b. Compulsory on Householders. c. Compulsory on both. MACCLESFIELD (Dk. Bower). On both Yes Almost Very few MANCHESTER (Dr. Leigh). Compulsory on practitioner Yes Yes None NEWCASTLE-upon-TYNE(Dr. Armstrong). The compulsory notification by householder is not insisted on when the medical attendant notifies On both Yes No friction No medical men have been known to refuse to notify. One case of concealment of Small-pox by a householder who had no medical attendant, led to infliction of a fine NORWICH (Dr. Crosse). Compulsory on practitioner Yes Yes None NOTTINGHAM (Dr. Whitelegge). Compulsory on practitioner to notify to householder; and upon householder to forward his notification certificate to M.O.H. On both In theory it is a little roundabout; but in practice the practitioner always notifies to me himself, and no time is lost. In the early days it obviated much opposition on the ground of "breach of professional confidence" Yes No OLDHAM (Dr. Niven). On both; practitioner receives 2/6 for each case reported No experience personally of other plans Plan here works well as regards medical practitioner; as regards householder, not so Cases have occurred, but no action has been taken PORTSMOUTH (Dr. Mumby.) On both I think ours is the best, as medical practitioners can tell their patients that it is their business also to notify Householders rarely notify. No friction with medical practitioners None; but in 3 years during which the Act has been in force, the Sanitary Authority has called the attention of doctors to the Act and stated that the Act will be enforced PRESTON (Dr. Pilkington) Compulsory on practitioner. Fee 2/6 paid for each certificate If no practitioner in attendance, compulsory on householder • • Yes Yes None •«. READING (Dr. Ashby). On both Yes. Practically only the practitioner notifies, but making it compulsory on householders as well, tends to prevent them from neglecting to have medical attendance in cases of infectious disease Yes No. RIPON (Dr. Kirkley) • • On both Yes, the best Yes None ROTHERHAM (Dr. Hardwicke). SALFORD (Dr. Tatham). Yes No On both It answers very well Far the best Yes Yes No Not one; notification is becoming more complete and satisfactory yearly I gladly givo you my evidence in favour of notification as I know it here, after 5 years' experience STAFFORD (Dr. Blumer) On both There has been no serious outbreak of infectious disease since our Local Act was passed, so that I am not in a position to give any opinion from practical experience Yes As a matter of fact the plan has resolved itself into the practitioner alone notifying. It has not yet been enlorced on householders stalybridge ,, On both Yes Yes None SUNDERLAND (Dk. Harris). On both I regard the dual system as the best Yes One in 2½ years TORQUAY (Dr. Kahkeek.) On both I know of no difficulty None WARRINGTON (Dr. Gornall). On both Prefer compulsory on practitioner; in fact the householder never does notify Answers admirably; never the slightest imitation None YORK (Dr. North). Yes; fee 2/6 Yes; no fee On both This is the best plan; notification by househoider is of no value Yes None I believe the whole system works without difficulty, though I am a general practitioner. Notification by householders will never be of any value DECEMBER, 1887.