WAN 39 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 1888. BY THE MEDICAL OFFICERS OF HEALTH. To which is appended the Report of the Analyst. London: ASHFIELD, STEAM PRINTER, BRIDGE ROAD WEST BATTERSEA. 1889 3 To the Board of Works for the Wandsworth District. Gentlemen, We have the honour to present our Report for the year 1888, on the vital statistics and sanitary condition of the Wandsworth District. The usual plan of framing the report has been adopted. A general summary of the statistics affecting the whole district, is followed by the different local reports which deal more in detail with different matters affecting the sub-districts. This is the first Sanitary Report on the Wandsworth District since the separation of the Parish of Battersea. This naturally affects the statistics to a great extent, and makes it more difficult to compare the figures in this report with those of preceding years. We have tried to get over this difficulty as much as possible by giving in several tables two lines of figures, one including and the other excluding Battersea. This reportupon the whole is very encouraging, although we have been visited by epidemics of Measles, Scarlatina and "Whooping Cough of a rather serious nature through the course of the year. We can assure you, however that no efforts on our part have been wanting to check the spread of these infectious disorders. We have the honour to remain, Gentlemen, Your obedient Servants, The Medical Officers of Health of the Wandsworth Districts 5 REPORT ON THE HEALTH AND SANITARY CONDITION OF THE WANDSWORTH DISTRICT DURING THE YEAR 1838. Population. Since the last annual report, the Parish of Battersea has been separated from the Wandsworth District. In considering the various figures and calculations submitted therefore, one must bear in mind that the Wandsworth District now consists of only the five parishes of Clapham, Streatham, Tooting Wandsworth, and Putney. The official population of the District in the middle of the year 1888, was, 139,078. This estimate is obtained by calculating the rate of increase since the last census at the same ratio as during the preceding decade. No doubt the estimate is very much below the actual population. As we get nearer the end of the decade, in increasing suburban districts such as this, the difference doubtless becomes greater. Births. The total number of births registered during year was 4,077—2,070 males and 2,007 females. The relative numbers in the sub-districts are given in Table I. 6 TABLE I. BIRTHS. RATES. Sub-Districts. Males. Females. Total. Birth-rate Rate of Natural Increase. Clapham 537 539 1076 24.3 11.9 Putney 192 174 366 23.4 11.5 Streatham 579 605 1184 26.3 14.8 Wandsworth 762 689 1451 44.3 21.7 Whole District 2070 2007 4077 29.5 14.9 The birth-rate per thousand living was 29.5. In the previous year the birth-rate of the district exclusive of Battersea was almost the same. Inclusive of Batterse; it was 33.7 per thousand. The rate of natural increase of the population, or excess of births over deaths was 16.1 Deaths. The total number of deaths registered during the year was 1,964—964 males and 1,000 females. The death-rates in the different sub-districts are compared in Table II. TABLE II. DEATHS. Death-rate. Sub-Districts. Males. Females. Total. Clapham 247 304 551 12.4 Putney 95 92 187 11.9 Streatham 261 254 515 11.4 Wandsworth 361 350 711 18.0* Whole District 964 1000 1964 13.4 *Excluding deaths in public institutions. 9 Table IV. shows that 328 deaths have occured in outlying institutions. Of these 174 occured in the Union Infirmary, 113 in General Hospitals, and 41 in the Hospitals of the Asylums Board. If these 328 deaths be added to those registered within the district it gives us a death. rate of 16.3. By means of Table IV. we are able to find the relative use of the out.lying institutions made by the different sub.districts. The figures given below show the number of deaths per thousand of the population, occurring in these institutions. 1887. 1888. Clapham 1.7 2.4 Putney 1.2 1.8 Streatham 1.2 1.5 Wandsworth 2.0 3.7 In Table V. are given the different percentages of the mortality in the various sub.districts according to the social position, etc. TABLE V. Sub-District. Population middle of 1888. Percentage of Total Population. Number of persons to 1 acre. Relative mortality 0, Industrial and classes. Industrial classes. Other classes. Clapham 44,146 31.7 35 62.4 37.6 Putney 15,970 11.4 7 67.3 32.7 Streatham 45,000 32.4 11 49.2 50.0 Wandsworth 33,963 24.5 13 70.5 29.4 In Table VI there is a general summary and classification of all deaths registered in the entire district cording to sex, age, and social position. TABLE VI. Summary of Deaths and their Causes, registered in the entire District during 1888, classified according to Sex, Age, and Social Position, and showing also the relative numbers in each Sub-district. POPULATION of entire District, (Census) 1881, 210,434, Including Battersea 103,172. Excluding Battersea. Official Population in middle of 1888, 139,078, Area in Statute Acres, 9,352. Total Deaths from each class of Disease in the entire District. Sub-Districts. Sex. Age. Social Position. 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. 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, Hankers, &c Middle & Trading Class, Shopmen, Clerks,&c. Industrial and Laboring Class. CAUSES OF DEATH 1. Zymotic. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 53 14 ... ... 39 22 31 15 37 1 ... ... ... ... ... ... 2 8 43 Scarlatina 14 5 ... 5 4 6 8 2 6 5 ... 1 ... ... ... ... 3 2 9 Diphtheria 53 16 2 30 5 23 30 6 27 17 2 1 ... ... ... ... 7 14 32 Whooping Cough 96 28 6 22 40 46 50 45 49 2 ... ... ... ... ... 2 6 15 73 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 13 5 2 1 5 5 8 ... ... 3 3 3 4 ... ... 1 4 ... 8 Diarrhœa, Dysentery, & Cholera 64 15 4 13 32 31 33 52 8 ... ... ... ... 4 ... ... 4 15 45 Erysipelas 5 ... 1 3 1 3 2 3 ... ... ... ... 1 1 ... ... 1 ... 4 Puerperal Fever 6 1 1 3 1 ... 6 ... ... ... 1 4 1 ... ... ... ... 3 3 Other Zymotic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 304 84 16 77 127 136 168 123 127 28 6 9 6 5 ... 3 27 57 217 II. Constitutional. Gout, and Rheumatism 18 4 2 2 10 11 7 ... 1 1 1 4 2 9 ... 1 1 6 10 Cancer and other Tumours 70 18 9 28 15 11 59 ... ... ... ... 4 27 38 1 9 12 20 29 Other Constitutional Diseases 12 6 1 ... 5 5 7 5 2 ... ... 1 1 2 1 ... ... 6 6 Tubercular Phthisis 162 38 20 28 76 75 87 11 7 1 9 80 43 11 ... 4 10 36 112 Tabes Mesa 45 9 3 5 28 35 10 31 10 ... 4 ... ... ... ... 1 3 4 37 Hydrocephalus 37 15 2 10 10 21 16 13 15 6 3 ... ... ... ... ... 5 7 25 Scrofula 13 6 1 6 ... 6 7 3 3 ... 3 2 1 1 ... ... 1 1 11 III. Local. Nervous 298 70 27 89 112 159 139 76 33 4 4 29 54 89 9 12 53 69 164 Circulatory 160 49 24 42 45 75 85 2 4 1 4 23 41 78 7 11 31 45 73 Respiratory 357 103 35 91 128 186 171 77 92 4 ... 30 45 99 10 14 25 87 231 Digestive 119 41 14 30 34 52 67 24 2 1 3 18 35 34 2 14 11 35 59 Urinary 50 9 5 14 22 33 17 ... 1 2 3 8 17 18 1 2 8 11 29 Generative 7 2 ... ... 5 ... 7 ... ... ... ... 6 1 ... ... ... 1 1 5 Locomotory ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Integumentary 4 1 1 1 1 2 2 1 1 ... ... 1 1 ... ... ... 1 ... 3 IV. Developmental Premature Birth, Low Vitality 146 48 8 50 40 89 57 146 ... ... ... ... ... ... ... ... 7 37 102 Congenital Defects 10 3 7 ... ... 5 5 10 ... ... ... ... ... ... ... ... ... 1 9 Old Age 96 34 6 31 25 38 58 ... ... ... ... ... ... 42 54 12 13 25 46 V. Violence 48 13 5 7 23 27 21 18 6 ... 3 4 11 4 2 ... 4 9 35 VI. Illdefined & not specified 8 ... 1 3 4 5 3 ... ... ... ... 1 4 3 ... ... ... 1 7 Totals 1964 553 187 514 710 971 993 540 304 48 43 220 289 433 87 83 213 458 1210 7 According to Table II. it will bo seen that the deathrate in the entire district was 13.4 per thousand. In Table III. we have a comparison of the Birth and Death-rates in the entire district during the last year. TABLE III. Birth-rates, Death-rates, and rates of Natural Increase in the entire district during the ten years 1878—88. Years. Birth-rate per 1000. Death-rate per 1000 excluding Battersea. Rate of Natural Increase. Death-rate including Battersea. 1878 32.0 17.0 15.0 19.8 1879 33.4 16.7 16.7 20.5 1880 28.9 15.0 13.9 17.5 1881 30.0 14.0 15.9 17.1 1882 30.8 15.5 15.3 17.4 1883 30.4 16.5 13.9 17.7 1884 32.3 15.3 l6.9 17.8 1885 30.0 13.0 17.0 16.8 1886 30.8 14.5 15.3 17.0 1887 30.4 13.3 17.1 15.7 Mean of Ten Years. 30.9 15.09 15.7 17.7 1888 29.5 13.4 16.1 In one column we have the death-rates exclusive of Battersea. From this it will be seen that the death-rate during 1888 compares very favourably with that of preceding years. Especially is this the case when we bear in mind that in all probability the actual death-rate would be considerably less on account of the rapid increase of the population. As it is, it is 1.69 less than the decennial average. It is also 5.7 less than the rate in 28 great towns of England and Wales. It is 5.1 less than the deathrate for the whole of London during the same period. 8 This is the more satisfactory, when we bear in mind that the year 1888 was remarkable for having by far the lowest death-rate ever yet recorded in London. Deaths in out-lying Institutions. The figures given above do not include the deaths of those inhabitants of this district who have died in outlying institutions The difference however is probably made up by the number of deaths occurring in the public institutions of the district, and which are included in our general table of mortality. TABLE IV. Deaths in Outlying Institutions. CAUSES OF DEATH. Number in Entire District. Clapham. Putney. Streatham. Wandsworth. Union Infirmary. General and Special Hospitals. Asylums Board Hospitals. Small Pox. 1 .. .. .. l .. .. 1 Scarlet Fever 17 10 .. 4 3 .. .. 17 Diphtheria 13 7 l 5 .. .. 11 2 Enteric Fever 5 2 .. 1 2 .. l 4 Whooping Cough .. .. .. .. .. .. .. .. Measles 3 1 .. .. 2 3 .. .. Other Zymotic Diseases 2 .. 1 1 .. .. 2 .. Tubercular Diseases 43 17 1 6 19 32 9 2 Cancer 25 8 2 6 9 8 17 .. Rheumatism 2 1 .. 1 .. 1 1 .. Respiratory Diseases 41 11 5 8 17 28 11 2 Circulatory Diseases 52 14 4 7 27 36 13 3 Nervous Diseases 43 11 7 12 13 19 16 8 Other Diseases 64 20 8 8 28 44 18 2 Violence 17 5 1 4 7 3 14 .. Total 326 107 30 63 128 174 113 41 11 Infantile Mortality. 540 of the total number of deaths occurred. among children under 1 year. This is a percentage of 27.5 of the total number of deaths. We get a better idea of the extent of infantile mortality when the number is expressed in relation to the number of children born, thus:— Deaths under 1 year per 1000 births — Year 1888. Year 1887. Wandsworth 16 114 Streatham 112 101 Clapham 155 122 Putney 213 151 According to these figures each sub-district presents a higher infantile mortality relative to the birth-rate than the previous year. Causes of Mortality It will be seen from Table VI that of the total number of 1964 deaths, 304 were caused by Zymotic disease. Diseases of the respiratory organs were the most fatal of all the different classes of disease ; 18.1 per cent of the total number of deaths were due to diseases of this nature. Last year these diseases were responsible for 19 per cent of the whole mortality. An interesting point in connection with the mortality tables is the prevalence of cancerous disease amongst us. It has lately been shewn by one authority especially that Cancer is on the increase. In the Wandsworth District during the year, 70 deaths were due to Cancer and other tumours, which is equivalent to 3.5 per cent of the total number of deaths. In the previous year the disease caused 2.9 per cent of the total deaths in the whole district including Battersea. In the year 1886 it caused 2.6 per cent of the total mortaliy. From these figures it would appear that cancerous disease has been somewhat on the increase in this district. 12 TABLE VII. Whole District Clapham. Putney. Streatham. Wandsworth. Total Deaths from Zymotic Diseases 304 84 16 77 127 Zymotic Deathrate 2.1 1.9 1.0 1.7 3.7 Death-rate from all Diseases 13.4 12.4 11.7 11.4 18.0 There were 304 deaths from Zymotic disease registered during the year. The Zymotic death-rate per 1000 living was 2.l and Zymotic diseases caused 15.4 per cent of the total deaths. In the previous year, the Zymotic death-rate for the district including Battersea was 2.72 and excluding Battersea, the Zymotic deathrate was only 1.4 per 1000. This increase in the Zymotic death-rate was chiefly due to the prevalence of epidemics of measles, scarlatina, whooping cough and diphtheria throughout the district. The details of and remarks upon these epidemics are given in the local summaries. The great wave of Scarlet Fever which passed over London towards the end of 1887 gradually went down, over London generally. In our own district however the epidemic seems to have affected us more towards its close than during the earlier period. During the year 1887, 22 deaths of inhabitants of this district were registered—12 at their own homes and 10 in the Hospitals of the Asylums Board. During the year 1888, however 31 deaths were registered from Scarlet Fever. 13 Measles. The prevalence and fatality of Measles calls for special remark. This is one of those zymotic diseases which is thought lightly of by people generally, and the treatment of which is therefore carried out in a casual and summary fashion. The statistics which we present, however show very distinctly that this idea is erroneous and fraught with danger. In our district 53 deaths from measles occurred during the year. While during 1887, 68 deaths resulted from this disease. In the whole of London during 1888, there were 2,401 deaths from Measles and 1,209 from Scarlet Fever. In the year 1887, there were 2,904 deaths from Measles and 1,443 from Scarlet Fever. This shows very remarkably the serious nature of this disease, and the havoc caused by it on the population compared with Scarlet Fever. In taking these two years for consideration, we must remember they were remarkable for a special outbreak of Scarlet Fever. Since the year 1870, the number of deaths from measles has gradually risen, while those from scarlatina have shown as great a tendency to gradually decrease. The explanation of this remarkable fact seems to be, that since that date, greater care and isolation have been insisted on in the case of Scarlatina than in the case of measles. The figures, however, given above, impress us with the necessity of following the same line in the case of one as with the other. 14 TABLE VIII. Infectious cases admitted into Hospitals of Asylums Board. Small Pox. Scarlet Fever. Enteric Fever. Typhus Fever Diphtheria. Clapham .. 68 4 .. 1 Putney .. 5 .. .. 1 Streatham .. 25 .. .. .. Wandsworth 3 39 6 .. .. Entire Wandsworth District 3 137 10 .. 2 Corresponding totals in 1887 1 103 10 .. .. Asylums' Board Hospitals. In Table VIII are given the number of cases admitted into these Hospitals tabulated according to the nature of the disease and the sub-district from which they came. There were thus 137 cases admitted from this district in comparison with 103 in the previous year. The admission of cases of Diphtheria marks an epoch in the history of the Asylums Board Hospitals. This change is likely to be attended with the most beneficial results. This disease is undoubtedly spread by direct contagion like other infectious disorders and the necessity for the change which has been made, to ensure isolation and to check the spread of the disease has been more than once pointed out in reports from this district. We are sorry to report that not much progress can be reported in regard to Compulsory Notification of Infectious Diseases. This step must sooner or later be adopted. 15 The following Table gives the Vaccinations performed in this district during the year 1887. There were 3,954 births registered and 3,267 successful vaccinations. 324 died unvanccinated. TABLE IX. SUBDISTRICTS. Number of Births Returned from 1st January to 31st December 1887. Successfully Vaccinated. Insusceptible of Vaccination. Had Small-pox. Dead Unvaccinated. Postponed by Medical Certificate. Removed to District Vaccination Officer of which has been duly apprised. Removed to places unknown, or which cannot be reached; and cases not having been found Clapham 1076 387 5 .. 88 38 9 58 Putney 351 286 2 .. 33 5 8 17 Streatham 1188 555 2 .. 103 38 21 69 Wandsworth 1339 1148 3 .. 100 15 3 70 Totals 3954 3297 12 .. 324 96 41 214 This leaves 363 children un-vaccinated which is equivalent to 10 per cent. inquests, etc. It will be seen from table X that 92 inquests were held in this district during the year. This is equivalent to 4.6 of the total number of deaths. In these inquest cases, death is attributed in about half the number to Natural Causes. Uncertified Deaths The number of deaths in which the cause was not certified by any medical man was 29. Of these 9 occurred in Clapham, 12 in Streatham, 7 in Wandsworth, and 1 in Putney. In the previous year there were 32 uncertified deaths. Sickness amongst Union Poor. During the year 1773 cases came under treatment compared with 1902 last year, the difference being chiefly accounted for by the diminished number of infectious cases. The proportion of deaths to cases treated was 4.3 per cent. 16 Sanitary operation In Table XII we have a great fund of information in regard to the sanitary work being carried on in the different parishes. Reference in detail is made to it more especially in the Local Summaries. TABLE X. Verdicts. Total Clapham Putney Streatham Wandsworth I. Deaths from Natural Causes: 43 8 8 12 15 II. Deaths from Violence: .. .. .. .. .. (a) Accidental; Poisoning Carbolic Acid 1 1 .. .. .. Poisoning Coal Gas 1 1 „ Alcohol 1 1 .. .. .. Falls 6 3 .. 2 1 Suffocation 14 5 1 1 7 Concussion and Fracture 2 .. .. 1 1 Burns 1 .. .. .. 1 Drowning 5 .. 4 .. 1 Other Injuries 5 .. .. .. 5 (b) Suicidal: Hanging 3 1 .. 1 1 Cut-Throat 2 .. .. .. 2 Drowning 2 .. .. .. 2 (c) Homicidal: Murder by Drowning 1 .. .. .. 1 Murder by Suffocation 1 .. .. .. 1 Open Verdicts: Fractured Ribs 1 .. .. .. 1 Found Drowned 3 .. .. .. 3 Totals 92 .. 20 13 17 42 17 TABLE XI. Sickness amongst Union Poor during 1888. SUB-DISTRICTS. Total Cases of Sickness treated in each Sub-District. Total Deaths in each Sub-District. 1.—Small Pox. 2—Measles. 3—Scarlatina 3—Diphtheria. 5—Whooping Cough. 6—Diarrhœa and Dysentery. 7—Cholera. 8—Fever. 9—.Erysiplas. 10—Puerperal Fever. 11 —Lung Disease. except Phthisis. 12—Phthisis. 13—Hydrocephalus, Atrophy Scrotum and Infantile Convulsions. 14—Violence, Privation, and Premature .Birth. 15—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. Clapham 565 29 .. .. 17 1 10 .. 6 .. 7 1 42 2 .. .. 5 .. 9 .. .. .. 165 12 13 3 10 1 27 7 254 2 Streatham 310 12 .. .. 4 .. .. .. .. .. 20 1 8 .. .. .. .. .. .. .. .. .. 57 4 7 .. 6 1 .. .. 208 6 Wandsworth 781 32 .. .. 37 2 2 .. .. .. 21 .. 23 1 .. .. 3 .. 5 .. .. .. 238 8 14 3 17 4 46 .. 375 14 Putney 87 3 .. .. .. .. .. .. .. .. .. .. 8 .. .. .. .. .. .. .. .. .. 25 1 4 .. 1 2 30 .. 49 .. Total 1773 76 .. .. 58 3 12 .. 6 .. 48 2 81 83 .. .. 8 .. 14 .. .. .. 485 25 38 6 34 8 103 7 886 22 TABLE XII. Summary of Sanitary Operations in the entire District during the year 1888. Clapham. Putney. Streatham. Wandsworth. Total. Number of Houses and Premises inspected 3589 2686 3995 4522 14792 1st Notices served 1034 404 476 535 2449 2nd Notices served 160 77 11 67 315 Number of houses disinfected after infectious diseases 66 12 85 288 451 Number of houses in which infectious disease recurred after disinfection .. .. .. 3 3 Number of houses from which bedding, &c., was burnt 3 .. 9 .. 12 Disinfecting apparatus at Putney, number of times used 5 14 .. .. 19 Overcrowding abated 2 2 4 .. 8 Rooms cleansed and repaired 404 17 140 6 567 Staircases & passages cleansed and repaired 65 1 37 9 112 New drains and drains relaid 170 215 2958 1214 4557 Number of feet of new sewers and branch drains 5294 3214 3954 3054 15516 Drains cleansed and repaired 260 75 136 64 535 Syphon traps fixed to drains 309 76 .. .. 385 Sinks altered to discharge outside over gullies 73 5 52 7 137 Bath and lavatory wastes altered to discharge outside over gullies 15 .. 31 .. 46 Rain water pipes disconnected from drains 26 3 103 .. 132 Water-closets cleansed and repaired 449 60 96 107 712 Water-closets, supply of water laid on to 12 54 75 231 372 Urinals cleansed, repaired or water laid on 9 1 20 .. 30 Accumulation of manure, &c., removed 75 19 42 12 148 Cesspools abolished 6 1 33 .. 40 Dust-bins provided 137 1 29 56 223 Stables drained or paved and cleansed 15 4 19 Yards drained and paved 95 16 11 1 123 Unwholesome or dilapidated houses cleansed & repaired .. .. 29 7 36 Leaky house-roots and gutters repaired 86 8 103 5 103 94 Houses supplied with water 10 7 13 26 56 Water-cisterns covered and repaired 517 39 28 24 52 556 Cistern overflow pipes disconnected from drains 6 .. 93 64 157 6 Well closed 1 .. 17 .. 18 Pig nuisances removed 2 3 3 .. 8 Unclassified nuisances 216 33 8 2 259 Cases investigated by Magistrates 3 2 34 87 121 4 9 Compulsory Orders obtained 1 .. .. 3 4 Compulsory works executed 1 2 .. .. 3 l LOCAL SUMMARIES. 21 CLAPHAM. Population. The population of Clapham, as estimated by the plan adopted by the Registrar-General was 44,145 in the middle of 1888, being an increase of 1,100 for the year. There is every reason to think, however, that the population of Clapham has increased more than is shewn in the estimate, and that the following death-rates, &c., are higher than would be the case, if the population were more accurately known. Births and Birth-rate. The number of births registered was 1,076, 537 of boys, and 539 of girls. The annual birth-rate was 24.3 per thousand of the estimated population, which was decidedly lower than that of any of the last eleven years. 22 The following table gives the relative proportions of the birth and death-rates, with the actual natural increase of the population for the 10 preceding years. TABLE I. Birth and Death rates. YEARS. Births. Birth-rate. Deaths from all Causes. Death-rate. Rate of Natural Increase. 1878 1,019 34.2 580 18.1 15.9 1879 1,125 34.1 561 17.0 17.0 1880 1,082 29.7 544 14.9 15.1 1881 1,059 28.9 499 13.5 15.3 1882 1,081 28.8 544 14.5 14.3 1883 1,085 28.2 580 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 1888 1,076 24.3 551 12.4 11.9 Deaths and Death-rate During the year 1888, 551 deaths, 247 of males and 304 of females were registered in the sub-district. These are equivalent to a death-rate of 12.4 per thousand of the estimated population, as compared with 13.93 in the previous year. The deathrate for the whole of London during the same period was 18.5 Table II. gives the number, causes, ages at death, and and social position of the deceased. 23 STATISTICS OF MORTALITY. CLAPHAM. Total deaths from each Class of Disease, &c., in the bub-District. Sex. Age. Social Position. Population Census) 1881 36,380 Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. From 10 to 20 years. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Class. Official population in middle of 1888 44,145 CAUSES OF DEATH. I. Zymotic. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 14 6 8 3 10 1 .. .. .. .. .. .. .. 1 13 Scarlet Fever 6 1 4 .. 3 2 .. .. .. .. .. .. .. .. 5 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 5 4 1 .. .. .. 2 2 1 .. .. 1 3 .. 1 Puerperal Fever 1 .. 1 .. .. .. 1 .. .. .. .. .. .. .. 1 Diphtheria 16 6 10 2 6 7 1 .. .. .. .. .. 1 2 13 Whooping Cough 28 13 15 18 10 .. .. .. .. .. .. 1 4 1 22 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa, Dysentery, and Cholera 15 6 9 14 1 .. .. .. .. .. .. .. .. 5 10 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 84 36 48 37 30 10 4 2 1 .. .. 2 8 9 65 II. Constitutional. Gout and Rheumatism 4 3 1 .. .. .. .. .. .. 4 .. 1 .. .. 3 Cancer & other Tumours 18 4 14 .. .. .. .. 1 7 10 .. 2 3 4 9 Other Constitutional Diseases 6 3 3 3 1 .. .. .. 1 1 .. .. 1 .. 5 Tubercular Phthisis 38 19 19 .. .. .. 2 20 15 1 .. 2 3 10 23 Tabes Messenterica 9 8 1 7 1 .. 1 .. .. .. .. .. 1 .. 8 Hydrocephalus 15 10 5 7 6 .. 2 .. .. .. .. .. 2 2 11 Scrofula 6 3 3 2 1 .. 1 1 1 .. .. .. 1 1 4 III. Local. Nervous 70 35 35 25 3 1 2 5 13 17 4 4 15 16 35 Circulatory 49 19 30 .. .. .. 2 7 8 29 3 5 8 12 24 Respiratory 103 42 61 24 21 1 .. 4 21 28 4 5 9 22 67 Digestive 41 16 25 8 1 1 1 5 14 11 .. 5 7 7 22 Urinary 9 7 2 .. .. .. .. 1 5 3 .. 1 2 3 3 Generative 2 .. 2 .. .. .. .. 2 .. .. .. .. 1 .. 1 Locomotory .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumentary 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 IV. Developmental. Premature Birth and Low Vitality 46 25 21 46 .. .. .. .. .. .. .. .. 3 10 33 Congenital Defects 3 .. 3 3 .. .. .. .. .. .. .. .. 1 2 Old Age 34 13 21 .. .. .. .. .. .. 14 20 4 4 7 19 V. Violence 13 6 7 5 4 .. .. .. 2 1 1 .. 2 2 9 Illdefined and Not Specified Illdefined .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 551 249 302 167 68 13 19 49 88 119 32 31 70 106 344 24 Deaths in Outlying Institutions During every year many inhabitants die in institutions external to the parish. The whole, of these persons returned in 1888 numbered 107, including deaths in the Union Infirmary, General and Special Hospitals, Hospitals of the Metropolitan Asylum Board, and the County and other Lunatic Asylums. If these deaths are added to those occurring within the boundaries of Clapham, we get a mortality of 658 during 1888, giving a rate of 14.9 per thousand as compared with 16.5 in the preceding year. Table III. gives full details of the numbers, ages, and causes of deaths in outlying Institutions. TABLE III. 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 10 4 6 1 9 .. .. .. 10 Diphtheria 7 4 3 .. 7 .. .. 5 2 Enteric Fever 2 1 1 .. 2 .. .. .. 2 Whooping Cough .. .. .. .. .. .. .. .. .. Measles 1 .. 1 .. 1 .. 1 .. .. Other Zymotic Diseases .. .. .. .. .. .. .. .. .. Tubercular Diseases 17 12 5 .. 16 l 10 6 1 Cancer 8 4 4 .. 6 2 3 5 .. Rheumatism 1 .. 1 .. .. 1 1 .. .. Respiratory Diseases 11 8 3 .. 6 5 7 3 1 Circulatory Diseases 14 9 5 .. 5 9 10 2 2 Nervous Diseases 11 6 5 .. 9 2 4 2 5 Other Diseases 20 7 13 2 6 12 16 4 .. Violence 5 3 2 1 4 .. 1 4 .. Total 107 58 49 4 71 32 53 31 23 25 It will be seen that 53 of these external deaths occured in the Wandsworth and Clapham Union Infirmary. 31 in the various general and special hospitals, and 23 in the Asylums Board Hospitals. Ages at Death. Of the total deaths 42 4 per cent were under 5 years of age, and 27.4 per cent were over 60 years of age. The true infantile death-rate, that is the proportion of deaths under 1 year to the population under that age was 150 per thousand as compared with 126 per thousand in the previous year. Social Position. relative number of deaths in the several social grades were as follows:— Nobility and Gentry 31 = 5.6 per cent. Professional Classes 70 = 12.7 „ Middle and Trading Classes 106 = 19.3 „ Industrial & Labouring Classes 344 = 62.4 „ Zymotic Diseases. The following table gives the number of deaths from specific fevers, as compared with previous years, and a similar comparison of Zymotic and general death-rates. The Zymotic death-rate was 1.9 per thousand of the estimated population. If the 19 deaths from Zymotic diseases that occurred in out-lying institutions, be added to these, the death-rate becomes 2.33 per thousand. 26 TABLE IV. Zymotic Mortality in Clapham. 1879 1880 1881 1882 1883 1884 1885 1886 1887 1888 Small-pox .. 2 7 1 .. 2 .. .. .. .. Measles 17 19 10 15 33 33 3 11 25 14 Scarlet Fever 12 21 15 26 8 3 .. 1 6 5 Diphtheria 1 3 3 4 7 8 4 6 10 16 Enteric Fever 9 4 3 7 3 4 8 3 4 5 WhoopingCough 25 25 13 17 16 15 25 34 25 28 Epidemic Diarrhœa 17 36 20 4 19 18 16 25 24 15 Other Zymotic Diseases 21 9 7 7 26 12 5 4 6 1 Total deaths from Zymotic Diseases 102 119 78 81 112 95 61 84 100 84 Zymotic Deathrate 3.1 3.4 2.1 2.1 2.9 2.3 1.49 2.00 2.32 1.9 Death-rate from all Diseases 17.0 14.9 13-5 14.5 15.1 13.7 12.4 12.9 13.93 12.4 Small Pox.—No cases of this disease came under notice during the year. Scarlet, Fever was the cause of 5 deaths in Clapham and 10 in out-lying institutions. There have come under notice 109 cases altogether. The death-rate from this disease is equal to .33 per thousand of the estimated population. The incidence of Scarlet Fever was most marked during the first quarter of the year,as in London generally, and since then has declined, causing however the mortality for the whole year to be higher than in 1887. The disease has generally presented symptoms of a mild type, and it is satisfactory to record that a larger proportion of the cases, than formerly, has been removed to the 27 tious Fever Hospitals. The difficulty of dealing with the disease has been greatly increased by the want of some system of compulsory notification, as many cases are not heard of till they become the cause of infection of a number of other persons. Measles and Whooping Cough were the cause of 42 deaths. This is less than in the previous year, but during the latter part of 1888 there was a considerable outbreak of Measles, during which most of the deaths occured. These were as usual, mostly due to chest affections, produced by exposure to the cold, when but just convalescent, and probably nearly all these deaths could have been prevented by ordinary care and precaution. Diphtheria—There were 16 deaths in Clapham and 7 in out-lying institutions from this cause. Altogether 48 cases have come to our knowledge during the year. This shows that, in common with London as a whole, there has been a considerable increase in the number of cases. This, of late, has been more marked year by year and the reason is not at all easy of explanation. This is a disease that is undoubtedly frequently caused by defective sanitary condition of dwelling houses, and in about half the total cases some defect has been discovered and remedied. It is also frequently spread by direct infection. and with regard to this, it is very satisfactory that the hospitals of the Metropolitan Asylums Board are now open for the reception of these cases, so that we may hope that, by prompt removal and isolation, the spread of this grave disease may be checked. Here again however the want of compulsory notification is severely felt. The cases have not been confined to one portion of the parish in particular, but have been more or less distributed over the district. Schools both public and private have been instrumental in spreading the disease, and I believe that. 23 if this extension of it by personal contact were stopped, we should have very few cases to deal with. Diarrhoea was the cause of fewer deaths than last year. This is to a large extent due to the coolness of the summer months, during which the death-rate from this cause is usually highest. inquests. Twenty inquests were held during the year, and the following verdicts returned:— 1. From Natural Causes 8 2. Accidental—Falls 3 Poisoning by Carbolic Acid 1 Poisoning by Coal Gas 1 Poisoning by Alcohol 1 Asphyxia—Children found suffocated in bed 5—11 2. Suicide—Hanging 1 Total 20 Uncertified Nine uncertified deaths occurred during the Deaths. year, two on statements by midwifes and seven on letters from the coroner. Sanitary During the year 3,589 houses and premises Proceeding of the year, have been inspected, and the total number of nuisances dealt with, amounted to 2,863, of these 2,323 were abated under notice, and 540 under promise. The table on page 18, gives a statement of the nuisances dealt with, that can be conveniently classified. The number of unclassified nuisances were 216 viz:— 39 new ventilating pipes, 15 ventilating pipes repaired, 29 water pipes repaired, 7 water closets ventilated, 24 soil-pipes repaired, 5 cases of carpet beating, 2 cases of clay burning, 9 workshops cleaned, 8 cases of insufficient water supply, 9 cases of water in the basements of houses, 8 29 sewers repaired, 15 dirty bake-houses, burning refuse, rain-water pipe discharging over footway, privy removed, shed used as a dwelling, shed cleansed, animals kept so as to be a nuisance, 2 cases of donkey keeping, cats, goats and rabbits. Three cases of non-compliance of notices to abate nuisances were investigated by the magistrate, in two the defendants agreed to comply, and in the other case the magistrate made an order for the work to be executed in 7 days. The Cow-houses and Slaughter-houses were inspected during September, and their sanitary condition found satisfactory. The Bake-houses have been inspected twice during the year. In April 26, and in October 25th, required cleansing and limewhiting. Inspectors Fairchild and Dee have merited the highest commendation for the zeal and tact they displayed in the discharge of their difficult duties. OLIVER FIELD, M.D. 30 PUTNEY & ROEHAMPTON. Population. The population of this sub-district is estimated to be 15,970 in the middle of the year 1888. This number it arrived at by calculating the increase since the last census at the same rate as obtained during the preceding decade. This calculation is, however, almost certainly much below the actual population. There has been an extraordinary expansion of the Parish during the last two or three years. This fact must be borne in mind in considering the birth and death rates in the various tables given below, inasmuch as they are considerably higher than they would be, if we had the actual population as our basis of calculation. Birth-rate. During the year 366 births were registered, 192 males and 174 females. Corrected for increase in the population there were 9 more births registered during 1888, than during the previous year. The birth-rate was 22.9 per 1000. In the whole of London during the same period the birth-rate was 30.7 per 1000. In Table I the birth and death rates are compared with those of the preceding 9 years. TABLE I. Birth and Death Rates. YEARS. Births. Birth-rate. Deaths from all Causes. Death-rate. Rate of Natural Increase. 1879 327 57 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 24.7 224 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 9.8 1883 366 22.9 187 11.7 11.2 31 Death and 187 deaths were registered during the year, 95 males and 92 females. The death-rate was 11.7. This is the lowest point at which the death-rate has touched during the last ten years with the exception of the year 1885, and is 6.8 below the recorded deathrate of the whole of London. Outlying The deaths enumerated above only include institutions. those registered within the district. Table II gives a return of those deaths of the inhabitants of Putney and Roehampton which have occurred in public institutions outside the parish. TABLE II. Deaths in Outlying Institutions. DISEASE. Sex. Age. Institutions. Total. Male. Female. Under 1. 1 to 60. 60 and upwards. Union Infirmary. General & Special Hospitals. Asylums Board Hospitals. Small Pox .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. Diphtheria 1 1 .. .. .. .. .. 1 .. Enteric Fever .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Disease 1 1 .. .. .. .. .. l .. Tubercular Diseases 1 . . 1 .. 1 . . 1 • • .. Cancer 2 1 1 .. 1 1 .. 2 .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases. 5 3 2 .. 4 1 3 2 .. Circulatory Diseases 4 .. 4 .. .. 4 4 .. .. Nervous Diseases Other Diseases 7 8 5 3 2 5 .. 1 4 2 3 5 2 6 5 2 .. .. Violence 1 1 .. .. 1 .. .. 1 .. Totals 30 15 15 3 13 14 16 14 .. It will be seen that 30 deaths have occurred in these institutions of which the majority occurred in The Union Infirmary. If these deaths be added to those registered in the district it raises our death-rate to 13.5 per 1000, as compared with 14.3 in the previous year. PUTNEY. Total Deaths from each Class of Disease. Sex. Age. Social Position. Population (Census) 1881 13,221 Official Population in middle of 1888 15,970 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. CAUSES OF DEATH. I. Zymotic. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. 2 .. .. .. 1 .. 1 .. .. .. 1 .. 1 Puerperal Fever 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 Diphtheria 2 1 1 .. 1 1 .. .. .. .. .. .. .. .. .. Whooping Cough 6 2 4 2 4. .. .. .. .. .. .. .. .. 1 5 Erysipelas 1 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 II. Constitutional. Diarrhoea, Dysentery & Cholera 4 2 2 3 1 .. .. .. .. .. .. .. .. •• 4 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 16 6 10 5 6 1 1 1 2 • • .. .. 1 3 12 Gout & Rheumatism Cancer & other Tumours Other Constitutional Dieases 2 9 1 2 2 7 1 .. 1 .. .. 1 .. 5 1 .. 4 2 1 Phthisis 20 10 10 .. .. 1 2 9 7 1 .. 2 3 15 Tabes Messenterica 3 2 1 9 .. 1 .. .. .. .. .. 1 .. 9 Hydrocephalus 2 1 1 1 1 .. .. .. .. .. .. .. .. 1 1 Scrofula 1 1 .. 1 .. .. .. .. .. .. .. .. .. .. 1 Nervous 27 15 9 12 6 4 1 .. .. 3 12 1 .. 12 3 12 III. Local. Circulatory 94 15 1 2 .. .. 5 8 8 .. .. 5 8 11 Locomotory 35 22 13 4 10 .. .. 6 4 11 .. .. 3 11 21 Integumentary 14 6 8 3 .. .. .. 2 3 6 .. .. 3 3 8 5 3 2 .. .. .. .. .. 4 1 .. .. 2 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumentary 1 1 •• 1 .. .. .. .. .. .. .. .. .. .. 1 IV. Developmental. Premature Birth and Low Vitality 8 8 8 2 • Congenital Defects Old Age 7 6 6 1 1 5 7 .. .. .. .. .. 2 4 .. 1 1 7 4 V. Violence 5 2 3 1 .. .. .. 1 2 1 .. .. .. 1 4 VI. Illdefined and Illdeflned .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Not Specified Not Specified 1 •• 1 .. .. .. .. 1 .. .. .. .. .. •• 1 Totals 187 95 92 40 24 3 4 26 37 47 6 .. 34 39 114 33 Deaths occurring In Table III all the deaths occurring in in Putney and Roehampton. Putney and Roehampton are recorded and classified according to sex. age and social position and cause of death 40 deaths occurred among children under 1 year of age which is equivalent to 21.3 per cent. of the total number of deaths. At 90 years of age and upwards 53 deaths occurred, or a per centage of the total of 28.3. In order to have a better idea of the mortality among children under 1 year of age, it is obviously necessary to compare the mortality with the number of births recorded during the year. For this purpose it is convenient to express the number of deaths occurring, in relation to a thousand births registered. Expressed thus, there were 109 deaths per 1000 births. Last year there were 151 deaths per 1000 births. This is known as The Infantile Death-rate. London generally showed an Infantile Death-Rate of 146, and the average of the 28 great towns of England and Wales was 154. Our figures this year are therefore very satisfactory when compared with these. This is doubtless to a large extent due to the facts that the population of this sub-district contains probably a larger proportion of the well-to-do classes, and that the population is not nearly so dense as in most other neighbourhoods. There are only 7 inhabitants to 1 acre. Social Position The relative number of deaths in the of Deceased. different social grades are given as follows: Nobility and Gentry 0=0 per cent. Professional Class. 34 = 18.2 ,, Middle and Trading 39 = 20.9 ,, Industrial and Labouring 144 = 60.9 „ The Labouring and Industrial classes yield therefore 00*9 of the total number of deaths. Last year the per- 34 centage was almost exactly the same. It is interesting to note that while the working classes yield 60.9 per cent, of all the deaths registered, they yield 75 per cent. of deaths from Zymotic diseases. TABLE IV. Zymotic Mortality in the Putney & Roehampton Sub-district. Zymotic Mortality. 1879 1880 1881 1882 1883 1884 1885 1886 1887 1888 Small Pox .. .. .. .. .. 1 .. .. .. .. Measles .. .. 6 13 2 1 4 4 2 .. Scarlet Fever 3 1 8 4 7 .. .. 1 1 .. Enteric Fever 2 4 1 4 2 10 3 1 .. 2 Diphtheria .. . . 1 29 24 .. 5 1 1 2 Whooping Cough. 8 9 3 8 2 8 1 18 2 6 Epidemic Diarrhœa 7 10 3 5 5 8 4 9 .. 4 Other Zymotic Diseases 7 1 5 6 2 •• 1 4 1 2 Total Deaths from 27 25 27 69 44 28 18 38 7 10 Zymotic Diseases 2.1 1 9 2.0 5.0 3.1 1.9 1.2 2.49 0.44 1.0 Zymotic Death-rate 15 0 13.6 12.5 15.1 17.1 13.7 11.2 11.8 12.5 11 7 Death-rate for all Diseases Zymotic Table IV shows, that we have been very free Diseases. indeed from Zymotic disease during the year. There have been no fatal cases of Small-Pox, Measles, or Scarlet Fever recorded. The Zymotic death-rate was only 1 per thousand of the population. This is the lowest it has been with the exception of the year 1887, during the last ten years. Although we have been very free from fatal cases of Zymotic Disease, a number of cases Scarlatina have occurred of a mild type. I am quite convinced that in the presence of an epidemic of this disease, the powers we possess are totally inadequate. In the first place in the absence of compulsory notification, cases may and do occur in crowded neighbourhoods without the fact coming to the knowledge of the sanitary authority until the period of convalescence when disinfection is required. In the second place, these cases 35 require such a lengthened period of isolation, that it is almost impossible to have it carried out efficiently in the dwellings of the poor. My experience is that in such cases during the period of convalescence, which is well known to be the most infectious time, children are allowed to get about and have ' the benefit of fresh air.' The seeds of the disease are thus scattered broadcast. It is difficult sometimes to blame the people in these cases. A whole family may only have two or three rooms at their disposal and undoubtedly, for them it is a much greater inconvenience to have one room set apart for one of their family who is sick, than for the wealthier classes occupying larger and more commodious houses. It appears to me that removal to hospital is the remedy for this state of matters, and until more compulsory powers are given, the sanitary authority will be seriously handicapped in the struggle against this disease. During the year thirteen inquests were held and the results are given in the following table. Inquests. Natural Causes 8 Drowning 4 Accidental (Sufocated in Bed 1 There was one uncertified death said to be due to diarrhoea and cramp on which an inquest was not held. Sanitary The Table giving the Summary of Sanitary Proceedings. operations during the year shows that a great amount of quiet useful Sanitary work has been done. There have been 2,686 houses and premises inspected. The entire parish is gone round systematically and periodically by the Sanitary Inspector. Besides this regular inspection any special case coming to the knowledge of the Medical Officer, is enquired into, and the necessary machinery put in motion. There were 404 notices served to remedy sanitary defects and second 36 notices had to be served in 77 cases. This is a larger proportion than in the preceding year, when only 17 second notices had to be served. Disinfection after infectious disease has been carried out in 12 houses. No case of disease has recurred after disinfection has been carried out. Vaccination. During the year 1887, out of 351 Birth returns, 386 were successfully vaccinated, 33 died unvaccinated, 2 were found insusceptible of vaccination; 5 were postponed by medical certificate, 8 removed to places duly notified, leaving 17 or 4.8 per cent unaccounted for. Sickness amongr The table given with the general sumParochial Poor, mary at the beginning, gives in a tabulated form the cases of sickness and death among the parochial poor. The chief fact which strikes one in connection with this table is the complete immunity from Zymotic disease with the exception of Diarhoea and Dysentery and even among these cases no death occurred. The usual inspections of the Cow-houses and Slaughter houses were made and their condition reported on before the renewal of their licenses. The Bake-houses also underwent the periodical inspection and were found satisfactory. All the Sanitary work of the Parish has been carried out, without the necessity of the intervention of the law except in two cases which were investigated by the Magistrate. No compulsory orders had to be obtained. All the facts collected and tabulated in the above tables give abundant evidence that the health of the parish is in a most satisfactory condition, and fully maintains the high standard to which we have hitherto attained. 37 In conclusion I beg personally to thank our surveyor Mr. Radford, for his kind assistance and support on all occasions, and to bear testimony to the zealous and effective manner in which the sanitary inspector carries out his somewhat difficult duties. Wm. Y. ORR, Medical Officer of Health for Putney and Roehampton. 38 STREATHAM AND TOOTING. Vital Statistics. Population. I estimate the population of Streatham and Tooting at 45,000 persons living in the middle of the year 1868, and base my calculation on the following grounds. There was an increase of 11,000 to the population in the ten years before the last census, giving a total of 25.553 in 1881. Assuming the same rate of increase on the last named figures, in the eighth year of the present inter-census decennium, there would be a population of 46,000. Mr. Bellamy, the Vestry Clerk, has been kind enough to furnish me with the number of inhabited houses in Streatliam, these he estimates at 6,711. Mr. Norris also informs me that there are 994 occupied houses in Tooting, thus there are in all 7,705 occupied houses in this subdistrict. Allowing the moderate computation of six persons per house we arrive at a population of 46.230, these figures corroborate the first calculation. The large increase in the number of births also support the foregoing estimates, and indicate such a population as they would imply; not to overstate the case however, I place the population at 45,000 persons living in the middle of the year 1888. v Birth and The number of births registered during the Birth-rate. 579 of males and 605 of females. The birth-rate, calculated from the total number of births and the foregoing estimate of the population was 20.3 per 1,000 persons living during the year. The 39 number of births have nearly doubled during the last ten years; in the year 1878 there were 609 births, in 1883 1184. Natural The rate of natural increase as represented by Increase. the excess of births over deaths was 14.86 per 1000 of the population. Deaths and During the year 1883, 515 deaths were registered in the sub-district, 261 of these were of males and 251 of females. They are equivalent to a death-rate of 11.4 per 1000, as compared with 11.6 in the year 1887, and the lowest death-rate recorded during the decennium. When to these deaths are added those of persons who died in various outlying, general and special hospitals, the death-rate is raised to 12.8 per 1000 as compared with 13 0 per 1000 last year. TABLE I Births and Death Rates. YEARS. Births. Birth-rate. Deaths from all Causes. Death-rate. Rate of Natural Increase. 1877 585 34.0 244 12.5 20.0 1878 609 34.4 284 16.7 18 0 1879 636 34.3 290 15.6 18 .7 1880 703 28.1 348 13 9 14.2 1881 830 32.1 313 12 1 20 0 1882 891 33.0 341 12 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 13.9 23.6 1886 1,07 8 34.3 473 15.0 19.2 1887 1,185 30.0 445 11.6 19.1 1888 11,84 26.3 515 11.4 14.86 The deaths that took place in outlying, general, and special hospitals are given in the following table, winch. 40 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. DISEASE. Sex. Age. Institutions. Total. Male. Female. Under 1. 1 to 60. 60 and upwards. Union Infinnary General & Special Hospitals. Asylums Board Hospitals. Small-pox .. .. .. .. .. .. .. .. .. Scarlet Fever 4 2 2 .. 4 .. .. .. 4 Diphtheria 6 1 4 .. 5 .. .. 5 .. Enteric Fever 1 1 . . .. 1 .. .. 1 .. Whooping Cough .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. Other Zymotic Diseases 1 . . 1 .. 1 .. .. 1 . . Tubercular Diseases 6 6 .. .. 6 .. 5 1 . . Cancer 6 3 3 .. 3 3 .. 6 . . Rheumatism 1 1 .. .. .. 1 .. 1 .. Respiratory Diseases 8 6 2 .. 6 2 3 5 .. Circulatory Diseases 7 3 4 .. 3 4 3 4 .. Nervous Diseases 12 9 3 1 7 4 5 7 .. Other Diseases 8 2 6 1 3 4 5 3 .. Violence 4 3 1 1 2 1 .. 4 .. Totals 63 37 26 3 41 19 21 38 4 There were 63 deaths in outlying institutions, 37 of males and 26 of females; 21 took place in the Union In- firmary, 38 in general and special hospitals, and 4 in the Asylums Board Hospitals. When these 63 deaths are added to the 515 that occurred in the sub-district, the death-rate is raised to 12 8 per 1,000, of the population. I may again observe that in comparing the death-rate of this and former years, we must not lose sight of the fact that only in the last four years have outlying deaths been included in the local death-rate. STATISTICS OF MORTALITY. STREATHAM & TOOTING. 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. Population (Census) 1881 25,553 Official population in middle of 1888 45,000 CAUSES OF DEATH. I. Zymotic. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 5 3 2 .. 2 2 .. 1 .. .. .. .. 2 2 1 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 1 1 .. .. .. 1 .. .. .. .. .. .. .. .. 1 Puerperal Fever 3 .. 3 .. .. .. .. 2 1 .. .. .. .. 3 ,, Diphtheria 30 14 16 3 16 9 1 1 .. .. .. .. 6 10 14 Whooping Cough 22 12 10 8 12 2 .. .. .. .. .. 1 .. 9 12 Erysipelas 3 2 1 2 .. .. .. .. .. 1 .. .. 1 .. 2 Diarrhœa, Dysentery, and Cholera 13 6 7 9 1 .. .. .. .. 3 .. .. .. 6 7 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 77 38 39 22 31 14 1 4 1 4 .. 1 9 30 37 II. Constitutional. Gout and Rheumatism 2 1 1 .. .. .. .. 1 .. 1 .. .. .. 2 .. Cancer & other Tumours 28 3 25 .. .. .. .. 2 10 15 1 5 4 6 13 Other Constitutional .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Phthisis 28 14 14 .. .. .. 1 19 7 1 .. 1 2 10 15 Tabes Messenterica 5 3 2 2 2 .. 1 .. .. .. .. 1 1 1 2 Hydrocephalus 10 5 5 1 5 4 .. .. .. .. .. .. 3 2 5 Scrofula 6 2 4 •• 2 .. 2 1 .. 1 .. .. .. .. 6 III. Local. Nervous 89 43 46 29 10 1 9 6 9 30 2 6 16 25 42 Circulatory Respiratory 42 91 23 51 19 40 .. 21 2 25 .. 2 .. .. 7 4 11 11 20 25 2 3 4 6 11 9 15 27 12 49 Digestive 30 18 12 6 .. .. 1 5 9 8 1 6 .. 9 15 Urinary 14 8 6 .. .. .. 1 5 4 4 .. 1 4 .. 9 Generative .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. Locomotory .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumentary 1 1 .. •• 1 .. .. .. .. .. .. .. .. .. 1 IV. Developmental. Premature Birth and Low Vitality 51 29 22 49 2 .. .. .. .. .. .. .. 3 20 28 Congenital Defects Old Age 31 16 15 .. .. .. .. .. .. 11 20 5 5 8 13 V. Violence 7 5 2 3 1 .. 0 2 .. .. 1 .. 2 .. 5 VI. Illdefined and Illdefined Not Specified Not Specified 3 1 2 .. .. .. .. .. 3 .. .. .. .. 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 515 261 254 133 81 21 9 56 65 120 30 , 36 69 156 254 42 There were 77 deaths in this class, 38 were their of miles and 39 of females. This yields a per .Prevalence and centage of l3.0 upon the deaths from all causes Fatality. during the year, as against 14.3 per cent last year, and gives a death-rate of 1.7 per 1,000 of the population. More than half the mortality was due to diphtheria and whooping-cough. 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 and Tooting Sub-district. 1879 1880 1881 1882 1883 1834 1885 1886 1887 1888 Small-pox .. .. .. .. .. ..••.. .. .. .. .. Measles 2 1 3 5 7 8 2 11 21 .. Scarlet Fever 5 31 13 9 2 8 .. .. 4 5 Diphtheria 2 7 1 4 13 3 5 6 7 30 Enteric Fever 3 5 2 9 8 4 6 3 2 1 Typhus Fever . . .. . . .. .. .. . . . . 1 . . Whooping Cough Epidemic 21 8 9 1 11 9 7 26 6 22 Diarrhœa 3 6 9 3 9 11 12 20 16 13 Other Zymotic Diseases 10 10 9 10 15 11 2 1 7 3 Total deaths from Zymotic Diseases 46 68 46 41 65 54 34 67 64 77 Zymotic Deathrate 2.2 2.7 1.7 1.6 2.3 1.8 1.1 2.1 1.6 1.7 Death-rate from all Diseases. 15.6 13.9 12.1 12.6 14.9 15.3 13.9 15.0 11.6 11.4 Referring to the table, it will be seen that there was no death from Small Pox, nor was any case removed to hospital, it may therefore be assumed that the disease was not present. 43 There were five deaths from Scarlet Fever, this is below the average of the last ten years, 30 cases were removed to hospital, where four died. The mortality from Diphtheria was very high, there were no less than 30 deaths, yet the total number of cases was not great, nor was the epidemic extensive. As far as can be ascertained without the aid of compulsoiy notification of infectious diseases, one of every two recorded cases was fatal, although doubtless there were many slight cases that escaped detection. The mortality was equally large in many other parts of London. The Registrar General in his annual summary says that " the deaths from diphtheria in the Metropolis not only exceeded the decennial average during the year 1888, but were higher than in any single year in the period in which diphtheria has been recognized as a distinct heading." It may well be asked why diphtheria should suddenly become so general and fatal with our yearly improvements in sanitation. The answer may be probably found in the circumstance that its spread is in the main, due to direct infection. In my contribution to last year's Annual Report I called attention to the importance of isolation and hospital accommodation for diphtheria, which then shewed signs of its approach in the wake of the wide spread epidemic of scarlet fever that pre vailed in London during 1886 and 1887 Early in October, 1888, the medical officers of health of the Wandsworth Board addressed a letter to the Sanitary Committee, calling attention to the increase of 44 theria in the Metropolis, and expressing their opinion that the isolation of persons suffering from the disease was one of the most imperatively necessary available measures for arresting its spread, and asking the Board to move Parliament to pass an Act. giving to the Metropolitan Asylums Board an authority for the reception into its hospitals of persons suffering from diphtheria. The Kensington Vestry had taken the initiative in this matter, and to Dr. Dudfield is mainly due the credit of our now being able to have hospital accommodation and effectual isolation in this, as in other infectious diseases. In this sub-district the disease was at its worst during theearlier months of the year. 1 investigated the outbreak and distribution of the disease very closely. It was for the most part amongst children attending schools.botli private and public, or amongst other children of the families these belonged to. That the disease spread by direct infection principally is very clear. The inspector's report book shows that of 40 houses inspected, including schools, only seven had any apparent defect, and the defects of the seven were not generally grave in character. The milk. upply was from several sources I strongly impressed on all concerned personally and through the Inspectors, the importance of longer isolation of convalescents than seemed to be thought nocessary, many moved about at once freely on recovery, and in this way and through overlooked slight cases the disease spread. There was only one death recorded from Typhoid Fever, but one case was removed to hospital, and died there. The 22 deaths from Whooping-Cough represent a 45 considerable prevalence of the disease, though doubtless the low temperature of the year raised the mortality. On the other hand there was a decline in the deaths from Diarrhoea, due to the cold wet weather in July and August. other These are grouped under five heads in the Mortality table:—Constitutional, Local, Developmental, Violence and Ill-defined. The total number of deaths from the diseases included under these various headings, was above the number recorded in 1887. Considered separately, there was a decline in the number of deaths from some diseases, and an increase in others. Cancer and other tumours showed an increase on the previous year. There was a considerable decrease in the tubercular class, it formed only 9T percent, of all deaths, as against 13.2 last year. There was a marked increase in the number of deaths from nervous, circulatory, and respiratory diseases, they form respectively 17.2, 8.1, and 17.6 of all deaths as against 134, 7 and 15 per cent. last year. There was an increase in the deaths from premature birth and low vitality, and a decrease in deaths from violence. The deaths from other diseases under the several headings do not differ sufficiently to call for remark. There was an increase in the number of Deaths of infants under one year of age, as compared with last-year, but the figures were below those 46 of the year before, they form 25.8 per cent. of all deaths, 41.5 per cent of all deaths took place before the age of five, and upwards of 47 per cent, before the age of twenty. There was a decrease in the mortality from tubercular diseases in early life, and a large increase in respiratory and nervous diseases. Thirty-one deaths are ascribed to old age, 16 of males and 15 of females, 150 deaths took place at and over 60, 54 of these ranged from 70 to 80, 21 were over 80, 3 were 90, and 3 were respectively 93, 94, and 97. The number of persons who were under the 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, 310 new cases came under treatment during the year, these do not include the many attendances on permanent paupers, only 29 of these were in the zymotic class as compared with 81 last year. They include 4 cases of Measles, 20 of Whooping-Cough, and 8 of Diarrhoea, with one death from Whooping-Cough. In the other classes were eleven deaths principally due to lung and brain diseases, old age and low vitality. The following table shows the percentage of deaths in the various classes during the year. Nobility and Gentry 36 = 7 per cent. Professional Class 69 = 13.40 „ Middle and Trading Class 157 = 30.48 ,, Industrial and Labouring 253 = 49.12 ,, Total deaths 515 = 100.00 47 The percentage of deaths showed an increase in the higher and industrial classes, as compared with the previous year. Seventeen inquests were held with the following results :— Natural—Heart Disease 4 Congestion of the Brain 1 Convulsions 4 Asphyxia from Whooping-Cough 1 Natural Causes 1 Marasmus 1—12 Accidental—Suffocated in Bed 1 Fall down Stairs 1 Injury to Head from Fall 1 Fracture of Skull, found dead j 1—4 on Railway Suicidal—Poisoned by Carbolic Acid 1— 1 Total 17 Twelve deaths were uncertified, double the number of last year, they were all submitted to the Coroner before being registered. The probable causes of death were as follows:— Low V itality 1 Epileptic Convulsions 1 Old Age 3 Convulsions 3 Cirrhosis of Liver 1 Cardiac Failure 2 Accidental Asphyxia during Birth 1 Total 12 A summary of the usual and principal sanitary works of the year will be found in table xiv. From this it will be seen that nearly 4,000 houses and premises were inspected, and the results recorded. The importance and value of such work cannot be over-rated 48 when thoroughly carried out, as I believe it is by our active and zealous Inspectois, Messrs. Phimister and Jones. There were 476 first notices (served to remedy defects and abate nuisances; only 11 second notices were required to ensure compliance, and much sanitary improvement was effected on requisition. An appeal to the law was not necessary in any case. Amongst the many important works of the year I may enumerate that there were 2,958 new drains, and drains relaid, 3,964 feet of new sewers and branch drains, 52 sinks were altered to discharge over gullies, 31 bath and lavatory wastes altered to discharge over gullies outside, 103 rain water pipes dis-connected from drains, 96 water closets cleansed and repaired, 75 had water laid on, 103 unwholesome and dilapidated houses were cleansed and repaired, 33 cesspools were abolished, 93 water cisterns were covered and repaired, pig nuisances were removed, accumulation of manure got rid of, &c. One hundred and thirteen rooms in 85 houses were disinfected, fumigated and cleansed after the infectious diseases, Scarlet Fever, Diphtheria and Typhoid, and in no case was there a recurrence of the disease. The fumigation and disinfection of houses after infectious diseases is carried out by the Inspectors, according to my instructions in a very complete and satisfactory manner. I am very glad to put this on record. The bake-houses have all been regularly inspected, and are in good condition. I personally inspected all the cow-sheds and slaughterhouses, and saw no reason to oppose a renewal of licenses. F. F. SUTTON, Medical Officer of Health. Streatham and Tooting. 49 WANDSWORTH. During the year 1888, disease and its attendant mortality in this sub-district were of much larger amount than in the year 1887. The latter, however, it will be remembered, was a year of comparative immunity from epidemics and of an unusually low death-rate. The excess of mortality in the past year was in great measure attributable to the occurrence of two severe epidemics of Whooping-Cough and Measles, the former of which prevailed with great fatality during the first six months, and the latter with almost equally fatal effect daring the latter six months of the year. Such excess, however, was not wholly due to those epidemics, for diseases of the non-zymotic classes also showed a large increase of mortality, the greatest proportion of which was furnished by diseases of the organs of respiration. Illustrations of these conditions will be furnished in the following pages. Vital Statistics. Population. The mean population of the sub-district during the year 1888, calculated according to the official method of the Registrar-General, amounted to 33,963. This estimate assumes a continuance of the same rate of increase since the period of the last census, as that which prevailed during the ten preceding years, and although sufficiently trustworthy when applied to large populations it is open to the objection, at least in this and most of the suburbs of the Metropolis, that it does not contain the means of computing the increase that may have resulted from im- 50 migration. That the latter has been disproportionately great of late years is evidenced by the progressive increase in the number of inhabited houses, as shewn by the RateBook, and by the remarkably large increase in the number of births in comparison with that of the last inter-census decade. The birth and death rates subsequently given are determined from the foregoing estimated population, and must therefore be accepted as, in all probability, much higher than they actually are. The births of 762 males and 689 females, . total 1,451, were registered during the year. The number is 113 more than in 1887. Allowing for increase of population the average number during the preceding ten years was 1,151; the births of last year therefore exceeded the average by 300, or 25 per cent. This excess, as already referred to, is indicative of a great accession to the population by immigration. Calculated from the official population the birth-rate was 44.36 per 1000, and the rate of natural increase 21.78 per 1000 persons living of all ages. The total deaths registered during the year numbered 711—361 of males, 350 of females. The average number during the ten years 1878—87, allowing for increase of population, was 643. The number of dea hs of the past year therefore exceeded the average by 68, and was greater than that of the preceding year by 101; the mortality, however, of the year before last as already stated was unusually low. No less than 126 of all deaths occurred in the following public institutions, viz:—in the Surrey County Lunatic Asylum 100; in the Workhouse 10; in St. Peter's Hospital 6; in the Hospital for Incurables 4; in the Prison 5; and 1 in the Patriotic Asylum for girls. 51 In addition to these which occurred in the foregoing institutions situated within the sub-district 128 were registered in other districts as having taken place in the following institutions without the sub-district, viz:—in the Infirmary of the Union 84; and in the Asylums Board and other hospitals of the Metropolis 44. These are shown in the following table, with the sex, age, and cause of death of the deceased. TABLE I. Deaths in Outlying Institutions. DISEASE. Total. Sex. Age. Institutions. Male. Female. Under 1. 1 to 60. 60 and upwards. Union Infiimary. General and Special Hospitals. Asylums Board Hospitals. Small Pox 1 . . 1 . . 1 . . . . . . 1 Measles 2 . . 2 1 1 . . 2 . . . . Scarlet Fever 3 1 2 . . 3 . . . . . . 3 Diphtheria . . . . . . . . . . . . . . . . . . Whooping-Cough . . . . . . . . . . . . . . . . . . Typhus Fever . . . . . . . . . . . . . . . . . . Enteric Fever 2 2 .. . . 2 . . . . . . 2 Diarrhoea . . . . . . . . . . . . . . . . . . Other Zymotic Diseases. . . . . . . . . . . . . . . . . . . Total Zymotic Diseases 8 3 5 1 7 . . 2 . . 6 Tubercular Diseases 19 13 6 2 14 3 16 2 1 Cancer 9 4 5 . . 4 5 5 4 . . Rheumatism . . . . . . . . . . . . . . . . . . Respiratory Diseases 17 13 4 2 5 10 15 1 1 Circulatory Diseases 27 12 15 1 10 16 19 7 1 Nervous Diseases 13 8 5 . . 10 3 8 2 3 Other Diseases 28 12 15 1 14 13 17 9 2 Violence 7 4 3 . . 7 . . 2 5 . . Total 128 69 59 7 7l 50 84 30 14 52 Death-rate. Calculated from the total deaths registered and the officially estimated population the death-rate of the past year was 18.07 per 1,000 inhabitants. In this estimate, correction is made for those institutions within the sub-district by which the mortality is unduly raised. These are the County Lunatic Asylums, St. Peter's Hospital and the Hospital for Incurables, the inmates of which institutions are almost exclusively derived from without the sub-district; moreover they undergo no natural increase, and are subject to a high mortality, the latter forming on an average about one-fifth of all deaths registered. If the deaths of Wandsworth inhabitants that occurred in institutions external to the sub-district be included in the calculation, the death-rate was 21.49 per 1,000; but this rate cannot be accepted as accurate, inasmuch as it includes the deaths of non-parishioners dying within the sub-district, of which there is no available record, but which probably approximate in number those of persons dying in outlying institutions. A lapse of seven years from the date of the last census, renders the determination of the population, and consequently of the birth and death-rate, by the official method more or less untrustworthy, in consequence of the disproportionately large increase of the inhabitants by immigration, as already shewn. Under such circumstances a far more reliable method of calculating the number of the population is derived from the proportional number of births, the ratio of which in a given population is found to be tolerably constant.—(See Report 1875, page 7). Estimated by the proportion which the mean annual number of births bore to the mean annual number of 53 persons living during the ten years 1878—87, the population of the past year was 36,597, yielding a birth.rate of 41.34 per 1,000, a rate of natural increase of 24.62 per 1,000, and a death.rate corrected for institutions, of 16.72 per 1,000. The Birth and Death rates for the past and ten preceding years, calculated by the official method, are compared in the subjoined table:— TABLE II. Birth and Death Rates. Years. Births. Birth.rate. *Deaths from all causes. Death.rate. Rate of Natural Increase. Corrected. Uncorrected. 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 1767 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 1840 24.59 1888 .. 1,451 44 36 711 18.07 20.90 21.78 * Deaths in Outlying Institutions not included. In the following table all the causes of death are exhibited; they are arranged in classes, in accordance with the system of the Registrar-General, shewing the age at death at eight periods with the number, sex, and social position of the deceased; the deaths from each disease of the zymotic class being set forth separately. TABLE III. STATISTICS OF MORTALITY. WANDSWORTH. Population (Census) l881 28,004 Official Population in middle of 1888 33,963 Total Deaths from each class of Disease, &., in the Sub-District. Sex. Age. Social Position. Mlales. Females. Under 1 year. From 1 to 5 years. From 5 to 15 years. From 15 to 25 years. At 25 and under 35 years of age. At 35 and under 55 years of age. At 55 and under 75 years of age. 75 years and upwards. Nobility 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 39 16 28 12 27 .. .. .... .. .. .. .. 2 7 30 Scarlet Fever 4 2 2 2 1 .. .. .. .. .. .. .. 1 .. 3 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 5 .. 5 .. .. 2 .. 1 2 .. .. .. .. .. 5 Puerperal Fever 1 .. 1 .... .. .. .. 1 .. .. .. .. .. .. 1 Diphtheria 5 2 3 1 4 .. .. .. .. .. .. .. .. .. 5 Whooping Cough 40 19 21 17 23 .. .. .. .. .. .. .. 2 4 34 Erysipelas 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 Diarrhoea, Dysentery, and Cholera 32 17 15 26 5 .. .. .. .. 1 .. .. 4 4 24 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 127 56 71 59 60 3 .. 2 2 1 .. .. 9 15 103 II. Constitutional. Gout, and Rheumatism 10 7 3 .. .. 1 1 2 2 4 .. .. 1 4 5 Cancer & other Tumours 15 2 13 .. .. .. .. 1 6 8 .. 2 1 8 4 Other Constitutional Diseases 0 2 3 2 1 .. .. 1 .. 1 .. .. .. 1 4 Phthisis 70 32 44 11 7 .. 4 32 1 4 8 .. 1 3 13 59 Tabes Mesenterica.. 28 22 6 20 7 .. 1 .. .. .. .. .. .. 3 25 Hydrocephalus 10 0 0 4 3 2 1 .. .. .. .. .. .. 2 8 Scrofula .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. III. Local. Nervous 112 66 46 16 16 1 .. 18 29 30 2 2 10 25 75 Circulatory 45 24 21 1 .. 1 2 4 14 21 2 2 7 10 26 Respiratory 128 128 57 28 36 1 • • l6 9 35 3 3 4 27 94 Digestive 34 12 22 7 1 .. 1 6 9 9 1 3 1 16 14 Urinary 22 15 7 .. 1 2 2 2 4 10 1 .. .. 7 l5 Generative 5 .. 5 .. .. .. .. 4 1 .. .. .. .. 1 4 Locomotory .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. \ Integumentary 1 .. 1 .. .. .. .. .. 1 .. .. .. 1 .. .. IV. Develop • Premature Birth, Low Vitality, and Congenital Defects Old Age 41 21 20 41 .. .. .. .. .. .. .. .. 1 5 35 25 8 17 .. .. .. .. .. .. 15 10 3 3 9 10 V. Violence 23 14 9 9 1 .. 3 1 7 2 •• •• .. 6 17 I. 11 definedand Ill-defined. Not specified (Not specified 1 1 .. .. .. .. .. .. 1 2 1 .. .. .. .. 3 1 Totals 711 361 350 198 133 11 15 89 99 147 19 16 41 152 502 55 Of the several groups of causes of death contained in the foregoing table, the Zymotic caused 127 deaths, and the Non-Zymotic 584; the latter comprising Constitutional 144, Local 347, and Developmental 66. Violence resulted in 23 deaths. In 4 instances the cause was too ill-defined to admit of classification. Zymotic Diseases. To diseases of this group, all of which, with two exceptions, belonged to the Epidemic or Contagious type, 127 deaths were referred, and were 26 above the corrected average number. They formed 17.5 per cent of all deaths, and represented a death-rate of 3.73 per 1,000 of the estimated population. The excess was due to Whooping-Cough, Measles, and Diarrhoea, the other members of the class being accompanied by less than their average fatality. Whooping- 40 deaths resulted from this disease, which was present during the whole year, the period of greatest fatality having been during the first six months. They exceeded the average number by 18. Measles. A very extensive epidemic of this disease prevailed during the latter six months of the year resulting in 39 deaths, or 23 in excess of the decennial average. Diarrhoea. From this disease 32 deaths resulted, most of which, as usual, occurred to young children. With one exception, that of an old man, they were exclusively confined to children under 5 years of age, 26 of them being infants under 1 year of age. Most of the deaths occurred as usual, in the summer quarter. From the three foregoing epidemics collectively 111 deaths resulted, all of which with the exception referred WhoopingCough. 56 to occurred to children under five years of age, and 55 of them to infants under 1 year. Scarlatina. 4 deaths only were registered as having occurred from this disease, but 3 others took place in Hospital. The combined numbers are three less than the average. Looking to the exceedingly infectious nature of this disease and the extent to which it prevailed in the adjoining parish of Battersea, the immunity enjoyed by this subdistrict is very remarkable. Diphtheria. Five deaths only were recorded from this disease, the average amount. Fever, Enteric The deaths from Fever numbered 5 only, and Typhus. 2 others occurred in Hospital. Conjointly the number coincides with the average. Small Pox. No death from this disease was registered. 3 cases, however, (two in one house), occurred in the summer, and were removed to hospital, where one died. The first case, which was the first recorded in the parish since August, 1885, was that of a young woman employed as a rag-cutter at McMurray's Paper Mills, South Street. The second was a young woman employed as a grasspicker at the same factory, and the third was her brother. Prompt removal of the patients to hospital, thorough disinfection of the houses, and re-vaccination of the inmates and others known to have visited the houses, prevented further extension of the disease. As an illustration of the efficacy of Vaccination it should be mentioned that an infant, aged 10 months, the child of the patient first attacked was found at the time to be unprotected by vaccination. It was at once vaccinated, and so escaped the disease. 57 Outbreaks of Small-pox are not unfrequently found to originate amongst those employed in the handling of rags at Paper Mills, and in this instance the circumstances and surroundings of the case admit of little doubt that the rags on which the first patient worked were the source of the infection. In defence of the public health therefore it would seem desirable that the disinfection of the rags before being sorted and cut up for use should be made compulsory by law upon all paper manufacturers, and other users of rags. Vaccination. From the return made by the Vaccination Officer to the Local Government Board it appears that, during the previous year (1887), of the 1,339 children born 1,148 were successfully vaccinated; 100 died unvaccinated; 15 were postponed on account of illness; 3 were insusceptible of the effects of the operation; 3 removed to places, the Vaccination Officer of which was duly informed, leaving 70 or 5.2 per cent who had removed to places unknown, or could not be found. The following table exhibits the total deaths that occurred from Zymotic diseases, specifying 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 and decrease of deaths in 1888 compared with the annual average number of deaths in 1878-87, raised in proportion to increase of population:— TABLE IV. COMPARATIVE TABLE OF ZYMOTIC MORTALITY. Diseases. 1878 1879 1880 1881 1882 . 1883 1884 1885 1886 1887 1888 1888. No. above corrected average. No. bel corrected average. Seven principle Epidemic Diseases. Small Pox .. 1 .. 9 .. .. 1 3 .. .. .. .. 1.6 Measles 4 16 9 5 18 14 6 19 28 20 39 23 .. Scarlet Fever 2 15 24 19 9 5 5 3 6 1 4 6.5 Diphtheria 4 1 4 1 3 11 4 6 10 2 5 .. .. fever(Typhus Enteric ) 3 8 6 4 9 12 4 4 8 6 5 •• 2 W hooping Cough 6 44 15 12 26 5 17 24 31 8 40 18 .. Diarrhoea 19 7 20 19 29 10 27 35 28 30 32 7 .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Total Deaths from above Epidemic Diseases 38 92 78 69 94 57 64 94 111 67 125 36 .. Other Zymotic Diseases 10 12 14 7 14 20 19 3 5 4 2 .. 9 Total Deaths from Zymotic Diseases 48 104 92 76 108 77 83 97 116 71 127 36 9 Zymotic Death. rate per 1,000 population 1.96 4.14 3.35 2.71 3.72 2.57 2.70 3.07 3.58 2.14 3.73 22 .. Total Deaths from all causes 422 516 484 507 544 499 576 628 722 610 711 68 .. Percentage of Deaths from Epidemics to Deaths from all causes. I 90 17.8 16.1 13.6 17.2 11.4 11.1 14.9 153 10.9 17.5 1.4 The months in which the deaths from Epidemic diseases occurred, with the mean temperature of each quarter are shewn in the sub-joined table. By far the greatest number of deaths are seen to have occurred in the third quarter mostly from Measles and Diarrhoea. The next greatest amount of fatality occurred in the fourth quarter principally from Measles, which caused 25 58 59 of the 37 deaths recorded. In the first quarter 22 of the 27 deaths occurred from Whooping-Cough, and in the second quarter 10 of the 16 deaths resulted from that disease. The climatic conditions associated with these deaths are that during the prevalence of the epidemics of Whooping-Cough and Measles, the great majority of the deaths from these diseases occurred in the autumn and winter quarters coincidently with an unusually low temperature, the latter operating unfavourably on these diseases by the development of pulmonic complications. DISEASE. January February March April May June July August September October November December Mean Temp. 36.9 Mean Temp. 51.6 Mean Temp. 57.6 Mean Temp. 44.6 Small Pox .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 4 4 6 9 14 2 Scarlatina 1 .. .. .. .. .. .. .. 2 .. .. 1 Diphtheria .. .. .. 1 .. .. .. .. 1 .. .. 1 Whooping Cough 7 9 6 4 5 1 .. 3 3 .. 1 1 Diarrhoea 1 1 .. 1 1 1 7 9 6 2 3 .. Fever 1 .. 1 1 1 .. .. .. .. 1 .. .. Totals 10 10 7 7 7 2 11 16 18 12 20 5 27 16 45 37 Non-Zymotic Diseases. Of this group diseases of the respiratory Local Diseases. organs produced the highest number of deaths. The latter amounted to 128, were 16 above the corrected average, and exceeded by one, the deaths from diseases of the Zymotic class. Of respiratory diseases, Bronchitis, which was the most fatal, caused 63 deaths, and Pneumonia 46. The excess of fatality from these diseases was for the most part borne by young children, and was most probably attributable to the remote effect 60 of the epidemics of Whooping-Cough and Measles, which as already shewn, extensively prevailed. Diseases of the Nervous System were the next most fatal of this group, causing 112 deaths, which were 27 below the average number; but in consequence of the disturbing influence of the County Lunatic Asylum, the numbers properly pertaining to the sub-district cannot be accurately determined. Next in order of fatality diseases of the Heart and Circulation caused 45 deaths, and were 12 above the average number. Diseases of the Digestive Organs resulted in 34 deaths, the average number. Diseases of the Urinary Organs caused 22 deaths, or 7 above the average. The other diseases of the group present but little variation from their respective averages. Constitutional The total deaths in this group amounted to one-fifth of the whole mortality. Diseases of the Tubercular class caused 114 deaths, and were 27 in excess of the average, Consumption which as usual was the most fatal single disease, contributing 76 of the number, or upwards of 10 per cent of all deaths. The other diseases of the group embracing Gout, Rheumatism, Cancer, and “other Constitutional diseases" caused 30 deaths, or 5 above the average number; and the deaths from Hydrocephalus and the wasting-diseases of children 38 in number shew some increase on the records of former years. Developmental To premature-birth, low vitality and congenital defects, 41 deaths were attributed, or 5 above the average. 61 The deaths from Age unassociated with disease were 25, or 9 less than the average number. Violence. The deaths from Violence numbered 23, and were 3 more than the average. III-defined or Under this head 4 deaths were recorded not specified. being 3 above the average number. In the following table the total deaths from Non-Zymotic diseases in the eleven years 1878-88 are enumerated and the increase and decrease of deaths in 1888 are compared with the annual average number of deaths in 1878-87, raised in proportion to increase of population:— TABLE V. COMPARATIVE TABLE OF NON-ZYMOTIC MORTALITY. Causes of Death. 1878 1879 1880 1881 1882 1883 1884 1885 1886 1887 1888 1888 .No. above corrected average. No. below corrected average. Developmental. Local. Constitutional. Tubercular 60 62 60 51 69 64 85 90 87 111 114 27 .. Other Constitutional 14 12 17 19 19 20 18 28 30 32 30 5 .. Nervous 111 96 106 121 106 116 128 145 151 115 112 .. 27 Circulatory 19 20 23 28 28 25 22 36 46 32 45 12 .. Respiratory 86 125 89 90 87 69 70 101 135 110 128 16 .. Digestive 9 21 21 28 28 35 47 22 30 30 34 .. .. Urinary 4 10 11 4 20 13 15 12 26 17 22 7 .. Generative 4 10 1 .. 4 .. 3 6 4 2 5 1.5 .. Locomotory 1 .. 3 2 1 .. 2 2 * * 1 .. .. 1 integumentary .. .. .. .. 1 •• .. 3 .. .. 1 .. 5 Premature Birth .. .. .. .. .. .. .. .. .. .. .. .. .. Malformation 18 18 27 37 27 23 40 37 45 38 41 5 .. Low Vitality Age 14 26 23 27 27 33 42 34 32 36 25 .. 9 Violence 13 11 11 20 18 32 21 15 17 13 23 3 .. III-defined or Not specified ) 1 1 .. 4 1 .. .. .. 3 2 4 3 .. 62. Death 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 1888. Decennial average. 1888. Decennial Average. Nobility and Gentry 2.25 3.44 0.00 1.14 Professional Class, Merchants, Bankers, &c 5.77 4.67 7.09 4.13 Middle & Trading Classes, Clerks, &c 21.38 23.66 11.31 19.22 Industrial and Labouring Classes 70.60 68.23 81.10 75.51 100. 00 100.00 100. 00 100 .00 The proportion of the general as well as of the zymotic mortality is seen, on reference to the table, to have been less amongst the nobility and gentry and the middle and trading classes, and greater amongst the professional and the labouring classes, than the decennial average. That it should have been greater amongst the latter in the presence of the extensively prevalent and fatal epidemics before referred to is not surprising; the cause of the increase amongst the professional class however is not apparent. Infant The actual death-rate of infants calculated Mortality. from the number of deaths under 1 year and the number of births during the year was l3.6 per cent, or not much above the decennial average which is per cent. But the proportion of deaths of children relative to the total mortality was excessive. Thus the 63 deaths of infants under 1 year of age amounted to 27.8 per cent, the average being 23.9 per cent; of children under 5 years of age 46.5 per cent, the average being 37.9; and of children under 10 years of age 48.1 per cent, the average being 40.6 . All deaths under 20 years formed 50.2 per cent, the average being 43.8. This high mortality of the young was mostly the result of the epidemics of Whooping-Cough and Measles, and diseases of the Breathing-Organs, probably to a great extent derived therefrom. Senile There was an increase in the number of deaths Mortality. at high ages. 89 deaths, or 12.5 per cent, having occurred at 70 years of age and upwards, the corrected average being 77. 25 of the number were recorded as having resulted from Age unconnected with disease. As usual the females by far exceed the males in number and longevity, the highest age, 96 years, being attained by a female. The sex and age of the deceased with the numbers at different periods are tabulated below:— Age Males. Females. Total. 70-75 22 26 48 75-80 9 13 22 80—85 5 8 13 85—90 1 3 4 92 . . 1 1 96 .. 1 1 37 52 89 64 Sickness and Mortalily of the Parochial Poor The nature, amount and fatality of the sickness that occurred amongst the parochial during the year are set forth in Table XI., page 17. The amount exceeded that of the previous year by nearly 100 cases, but the resulting fatality was proportionally less. The total number of fresh cases coming under treatment was 781, and the resulting deaths 32, or 4 per cent. As in the year previous the most prevalent diseases of the Non-Zymotic class were those of the respiratory-organs which numbered 238, or over 30 per cent of the whole, and caused 8 deaths. The Zymotic diseases that prevailed were Measles, 37 cases with 2 deaths; Diarrhoea 23 cases and 1 death; Whooping-Cough 21 cases; the latter, with 2 cases of Scarlatina, 3 of Fever, and 5 of Erysipelas were unattended with fatality. Inquests, Violent deaths Uncertfied Death. The causes of death of 42 persons, 27 males and 15 females, were investigated by Coroner's Inquest during the year. The number is 8 less than in the year previous. 7 deaths were uncertified by medical testimony, but 5 of them were referred to the Coroner, who considered an inquest unnecessary. Verdicts of "death from natural causes" were returned in 15 instances, and from Violence in 23 instances; 16 of the latter were the result of accident, 5 of Suicide and 2 of Wilful Murder. In 4 cases the primary cause of death was undetermined. These particulars are shewn in the following table:— Males. Females. Total Deaths from natural causes 10 5 15 65 Deaths from violence, viz:— Run over by cart through tailing from the shaft 1 — Burns 1 — Drowning — 1 Suffocation 4 3 Fracture of Skull from a J fall 1 — Accidental Hoemonhage from want 16 of proper attention Child birth — 1 Fall on the head at birth 1 — Poisoning by an overdose of Chlorodyne — 1 Explosion at Toy-Firework Factory — 2 Cut-throat 2 — Suicidal Cut-throat and drowning 1 _ Hanging 1 — Drowning — 1 Murder by drowning in a Homicidal Wash-tub — 1 1 2 (Murder by Suffocation 1 —) Primary came Fracture of ribs and ster- undetermined num 1 Found drowned 3 — 27 15 42 Sanitation Details of the sanitary proceedings that were carried out during the year are, as far as they can be so dealt with, enumerated in Table XII, page 18 The figures therein contained, represent in a small space a very extensive amount of sanitary work The numbers, especially such as relate to the important procedure of house to house inspection, (which it may be added is carried on as a daily routine), considerably exceed those of the previous year The number of houses so inspected and their sanitary condition recorded in the HouSe-Inspection book amounted to 4,522, being 73 more than in 66 1887. It should here be observed that the information derivable from the inspection of houses, the Record of Zymotic diseases and the Returns of the Registrar-General would be of much more practical value if the houses throughout the sub-district were uniformly numbered. As yet the name cf a house or very often the name of a street only in which a death has occurred forms the sole guide to identification; the latter it need scarcely be observed, becomes under such circumstances difficult and occasionally impossible. Irrespective of the figures in the table referring to new sewers and drains, water supply, dust-bins, &c., connected with the building of new houses, there were 1,355 separate items of procedure by which defects of houses, drains, water-closets, sinks, water-cisterns, &c., were made good, and a variety of nuisances removed. The disinfection and purification of houses after the presence of infective diseases were unremittingly pursued; 288 houses, or 96 more than in the previous year were so dealt with; and in 3 instances only was there a recurrence of disease, and even in these the intervals between disinfection and the periods of attack, and other circumstances were such as to throw doubt upon their having been really cases of recurrence. Sulphur fumigation was, as heretofore the disinfecting agent employed, and no better evidence than that furnished by the foregoing results could be afforded of its trustworthiness. In addition to these 734 complaints were brought to the notice of the Local Committee, and duly attended to. Several formed the subjects of special reports of which the most important were the following:— Nuisance from deposit of gas-lime at Riverbank, the Oziers. Nuisance at Ford's fat-melting premises, Bendon Valley. „ Pease's „ Garratt Park. „ Lathwell's „ Bendon Valley. ,, from discharge of sewage into open ditch, Burntwood Lane. ,, at Harrison, Barber & Co., Horso-slaughterers, Garratt Lane. ,, from a pond and piggery, noar Burntwood House. 67 Police Court Cases. The three first and a seizure of unsound pork were the only cases that required an appeal to the Magistrate, but these necessitated nine attendances at the police court. Cow Houses All the cow-houses in the sub-district and Slaughter Houses. 18 in number, and the slaughter-houses 8 in number were as usual examined, and their condition reported on as satisfactory, prior to the renewal of the licenses of their owners. Bake-houses. The bake-houses also numbering 39 underwent inspection twice in the year, and with the exception of two, in which lime-whiting had been omitted, and in one of them a proper water supply was required, their conditions were all found to be in accordance with the regulations. The sanitary procedure of the year has been fully equal to the requirements of the sub-district, although the sanitary staff experienced considerable pressure in carrying out the disinfection of houses, &c., during the prevalence of the epidemics before referred to; and I have much pleasure in bearing testimony to the very satisfactory manner in which the Sanitary Inspectors have fulfilled their several duties. GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsworth. 68 REPORT OF THE PUBLIC ANALYST ON THE RESULT OF THE EXAMINATION OF THE SAMPLES OF FOOD SUBMITTED TO HIM DURING THE YEAR 1888. To the Wandsworth District Board of Works. Gentlemen, I have the honour to report that, during the year 1883, I received 252 samples of food from the Inspector and duly submitted the same to an exhaustive examination. These samples covered as large an amount of ground as the restricted number with which I am now allowed to deal would permit, and they included such of the chief articles of diet as were known by past experience to be likely to exhibit some amount of impurity. It will be seen from the following table that, out of the whole 252 samples, 225 were found to be genuine, while 27 proved to be more or less unsatisfactory. This shows a total amount of adulteration equal to 10.71 per cent., probably due to an improved efficiency in the inspection; but on this point it is only fair to state that the 69 general experience in all the surrounding districts has gone to show that, during the latter half of the year, the amount of adulteration has been everywhere on the increase. Nature of Article submitted. Total number. Pure. Slightly impure. Impure. Per cent. of adulteration. Milk 68 45 3 10 22.5 Butter 46 38 0 8 17.4 Bread and Flour 33 33 0 0 0 Coffee 31 29 1 1 6.4 Sugar 21 21 0 0 0 Pepper 15 13 1 1 13.3 Lard 9 7 2 0 22.2 Mustard 9 9 9 0 0 Tea 6 6 0 0 0 Arrowroot 4 4 0 0 0 Oatmeal 4 4 0 0 0 Sweets 4 4 0 0 0 Tapioca 3 3 0 0 0 Sago 3 3 0 0 0 Whiskey 3 3 0 0 0 Yeast 2 2 0 0 0 Pickles 1 1 0 0 0 252 225 7 20 10.71 As usual, the various dairy products head the list and it may almost be said, that, if it were not for the dealers in such commodities, the Public Analyst's occupation would be almost gone. It is pretty certain that, even now, a great number of small adulterations up to 10 per cent, (and sometimes more), escape without detection, because of the variable strength of such products according to the breed of the cattle and the season of the year. Analysts adopt a limit of strength and no sooner have they done so, than some one discovers that certain cows do not give an article coming up to it and so it has to be once more reduced. As an example of this difficulty I may mention that a certain class of butter imported from Denmark, which, on analysis by the ordinary standard, indicated nearly 20 per cent, of added fat, has been shown TO to be absolutely genuine. The only remedy appears to consist in the fixture, by the legislature, of fair average standards, below which everything should be legally unsaleable. If this were done, the breeders of milk stock would soon work up to it, and foreigners would have to find some other market for their poor butter. No substantial injustice would be done, because it is a fairly disputable question whether the man who produces natural milk with too much water in it does not defraud the public just as much as if he bred good milk and put the water in afterwards. Until this end has been attained however, we can only continue to take the lowest possible limit that the natural article has been known to reach and to pass all samples over that limit as "genuine." I have the honour to be, Gentlemen, Your obedient servant, JOHN MUTER, F.R.S. (Edin); F.I.C., Public Analyst.