WAN 40 The Board of works for the wandsworth District. SANITARY DEPARTMENT. REPORT ON THE SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISE IN THE WANDSWORTH DISTRICT. DURING THE YEAR 1889. BY THE MEDICAL OFFICERS OF HEALTH. ASHFIELD & YOUNG, PRINTERS, BRIDGE ROAD WEST, BATTERSEA 1890. 68674 The Board of works for the wandsworth District. SANITARY DEPARTMENT. REPORT OX THE SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE WANDSWORTH DISTRICT. DURING THE YEAR 1889 BY THE MEDICAL OFFICERS OF HEALTH. London: asiifield & young, printers, bridge road west, battersea 1880 Wellcome Library for the History and Understanding of Medicine To the Board of Works for the Wandsworth District. Gentlemen, We have the honour to present our Report for the year 1889, on the vital statistics and sanitary condition of the Wandsworth District. The same plan has been followed in framing the report, as that which we have adopted in former years. The report for the year is highly satisfactory from a Sanitary point of view We have had no great epidemic waves of infectious disease to encounter, and the result has been that we have greatly reduced death-rates, especially the deathrate resulting from Zymotic diseases. The Sanitary work of the district goes on smoothly, and with an increasing degree of efficiency. We have the honour to remain, Gentlemen, Your obedient Servants, The Medical Officers of Health for the Wandsworth District. 5 REPORT ON THE HEALTH AND SANITARY CONDITION OF THE WANDSWORTH DISTRICT, DURING THE YEAR 1889. Population. Since the last annual report, the registration district of Streatham and Tooting has been sub-divided. In this report the Parish of Tooting is a registration subdistrict by itself. This fact therefore must be borne in mind in considering the figures in reference to the Parish of Streatham. The official population of the Wandsworth District in the middle of the year 1889 was 142,108. This estimate is obtained in the usual way by taking the population at the last census as a basis of calculation, and adding to it the increase since that date. This increase is estimated as having gone on at the same ratio as obtained during the last inter-censal period. This estimate is almost certainly very much under the actual population at the present time. Births. The total number of births registered during the year was 4,078—2,068 males and 2,010 females. In table I. the relative numbers and birth-rates in the different sub-districts are given. The birth-rate over the entire district was 27.5 per thousand per annum. The rate of natura increase of the population was 15.4 per thousand. 6 TABlE I. BIRTHS. RATES Sub-Districts. Males. Females. Total. Birth-rate Rate of Natural Increase. Clapham 565 556 1121 24-3 12-7 Putney 202 174 376 23.0 11.9 Streatham 536 484 1020 25.5 15.2 Tooting 79 67 146 24.3 11.1 Wandsworth 686 729 1415 40.6 26.5 Whole District 2068 2010 4078 27.5 15.4 Deaths. The total number of deaths registered was 1,698—851 males and 847 females. In table II. the death-rates in the various sub-districts are recorded. The death-rate for the entire district was 116 per thousand per annum. TABLE II. DEATHS. Death-rate. Sub-Ditsricts. Males. Females. Total. Clapham 246 258 534 11.6 Putney 85 97 182 11.1 Streatham 2.8 182 410 10.2 Tooting 50 28 78 13.16 Wandsworth 242 252 494 11.81* Whole District 851 847 1698 11.69 * Excluding deaths in public institutions. 7 Table III. gives us the advantage of comparing the birth and death-rates in 1 the entire district during the last ten years. This reveals the fact which is also brought out in the Registrar General's Annual Summary for London that the year was remarkable for having had the lowest death-rates on record. TABLE III. Birth-rates, Death-rates, and rates of Natural Increase in the entire district during the ten years 1879— 89. Years. Birth-rate per 1000. Death-rate per 1000. Rate of Natural Inerease. 1879 33.4 16.7 16.7 1880 28.9 15.0 13.9 1881 30.0 14.0 16.0 1882 30.8 15.5 15.3 1883 30.4 16.5 13.9 1884 32.3 15.3 17.0 1885 30.0 13.0 17.0 1886 30.8 14.5 16.3 1887 30.4 13.3 17.1 1888 29.5 13.4 16.1 Mean of Ten Years. 30.6 14.7 15.9 1889 27.5 11.6 15.8 In this district we have attained the very low deathrate of 11.6 per thousand, while the mean for the preceding ten years was 14.7. In London generally the deathrate was 17 4 and the birth-rate 30.3 per thousand. Both the birth and death-rates were the lowest ever recorded in this district, while the rate of natural increase of the population remains about the average. Deaths in Outlying Institutions. The deaths recorded in the preceding tables do not include the inhabitants who died in institutions without the district, 8 TABLE IV. Deaths in Outlying Institutions. CAUSES OF DEATH. Number in Entire District. Clapham. Putney. Streatham. Tooting. Wandsworth. Union Infirmary. General and Special Hospitals. Asylums Board Hospitals. Small Pox • • • • • • • • • • • • • • • • • • Scarlet Fever 6 0 • • 4 • • 2 • • 1 5 Diphtheria 12 6 • • • • • • 4 • • 7 5 Enteric Fever 2 • • • • 1 • • 1 • • 1 1 Whooping Cough .. 4 2 • • • • • • 2 3 1 .. Measles 2 1 • • • • 1 • • • • 2 .. Other Zymotic Diseases 9 2 • • 2 • • 5 3 6 • • Tubercular Diseases 52 18 1 6 2 25 27 24 1 Cancer 21 7 l 3 1 9 8 13 • • Rheumatism 1 0 • • • • 0 1 • • 2 • • Respiratory Diseases 33 8 7 2 2 14 19 13 1 Circulatory Diseases 28 9 3 4 7 17 11 0 Nervous Diseases 39 11 1 7 1 19 18 18 3 Other Diseases 62 21 10 9 2 20 41 20 1 Violence 15 6 1 5 0 3 3 12 Total 286 91 28 42 13 112 140 129 17 Corresponding Totals in preceding year 328 107 40 63 128 174 213 41 Through the Registrar General's Office we are enabled in table IV. to give the number of such deaths and to classify them according to the Parishes from which they come and to the different institutions in which death took place. Here again as in the general mortality tables there are fewer deaths registered than in the preceding year. The total number of such deaths recorded was 286 while in the year 1888 there were 328. If these 280 deaths be added to the number registered within the 9 district, we have a grand total of 1,984 deaths which is equivalent to a mortality of 13.9 per thousand. This estimate of the mortality is, however, not a correct one. It is evident that while a certain number of our parishoners die in these institutions without the district, it is equally certain that numbers die within our borders who have come from outside districts. We are enabled by table IV. to find out to what extent these different hospitals are taken advantage of by the various parishes, and the result corresponds with our experience in former years. The figures given below show the number of deaths per thousand of the population in the respective sub-districts, occurring in these institutions. 1888. 1889. Clapham 2.4 1.9 Putney 1.8 1.7 Streatham 1.5 1.0 Tooting 2.6 Wandsworth 3.7 3.2 From this it is apparent that Wandsworth and Tooting are the sub-districts from which the larger proportion of patients are received into these institutions. Table V. is interesting from the information it gives as to the proportion of the general mortality which falls on the industrial classes. TABLE V. Sub-District. Population middle of 1889. Percentage of Total Population. Number of persons to 1 acre. Relative mortality of Industrial and other classes. Industrial classes. Other classes. Clapham 45,990 32.4 37 57.3 42.7 Putney 16,330 11.4 7 63.2 30.8 Streatham 40,000 28.2 13 40.7 59.3 Tooting 5,000 3.6 9 48.7 51.3 Wandsworth 34,788 24.4 14 66.6 33.4 TABLE VI Summary of Deaths and their Causes, registered in the entire District during 1889 classified according to Sex, Age, and Social Position, and showing also the relative numbers in each Pub-District. population; of entire District, (Census) 1881, 103,172. Official Population in middle of 1888, 142,108, Area in Statute Acres, 0,352. CAUSES OF DEATH. Total Deaths from each class of Disease in the entire District. Sub-Districts. Sex. Age. Social Position Clapham—Population, 45,990, Area in acres, 1.233. Putney—Population, 16,330, Area in acres. 2,176. S trtatham—Population, 40,. 00, Area in acres, 2.904. Tooting—Population, 5,187, Area in acres. 561. Wandsworth—Population 34,778, 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. From 20 to 40 years. From 40 to 60 years. From 60 to 80 years. 0 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle & Trading Class. Industrial and Labouring Classes. Small pox •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• i. Zymotic Whooping Cough 39 15 6 9 3 6 19 20 14 •• •• •• •• •• •• •• •• •• •• Measles 31 11 2 5 6 7 15 16 6 21 3 1 •• •• •• •• 1 1 9 20 Scarlatina 5 2 1 1 1 •• 4 1 2 3 •• •• •• •• •• •• •• •• 1 1 Diphtheria 30 17 •• 6 1 6 18 12 1 22 3 3 1 •• •• •• 1 2 7 20 Typhus Fever 1 •• •• •• •• 1 1 •• •• 1 •• •• •• •• •• •• •• 1 •• Enteric Fever 9 4 1 1 •• 3 4 5 •• •• •• 4 4 1 •• •• •• •• 3 6 Diarrhoea, tery & Cholera 41 11 0 8 1 21 16 25 38 •• ••.. •• •• 1 2 •• •• 2 11 28 Erysipelas 5 •• 2 1 •• 2 2 3 •• •• •• •• •• 3 2 •• •• •• 2 3 Puerperal Fever 3 2 •• •• •• 1 •• 3 •• •• •• 1 •• •• •• •• •• •• •• 3 Other Zymotic 5 4 •• 1 •• •• 1 4 •• •• 2 1 •• 2 •• •• •• 1 •• 4 Totals of Zymotic Class 169 66 12 32 12 47 79 90 61 71 9 10 7 7 4 0 2 14 44 109 II. Constitutional. Gout, and Rheumatism 14 6 •• 3 1 4 6 8 •• .. 3 1 1 5 4 •• 1 3 4 6 Cancer and other Tumours 68 21 6 18 2 21 22 46 •• •• 1 1 5 25 32 4 6 11 19 32 Other Constitu- tional Diseases 15 2 1 •• 5 7 8 7 7 1 •• •• 1 3 2 1 •• •• 7 8 'Tubercular Phthisis 131 46 17 26 3 47 78 61 5 7 3 16 58 41 9 .. 2 24 38 75 Tabes Mesa 40 9 3 9 19 24 16 23 13 2 1 1 •• •• •• 1 2 10 2( Hydrocephalus 34 13 4 11 1 5 27 7 16 13 4 •• 1 •• •• •• 1 9 24 Scrofula 6 1 •• 4 •• 1 3 3 1 3 •• •• •• 2 •• •• I •• 4 1 Nervous 282 74 32 77 9 90 144 138 58 23 7 5 24 55 92 15 12 31 97 142 III. Local. Circulatory 146 56 17 37 10 26 60 80 2 0 3 5 20 45 61 10 12 27 41 6( Respiratory 302 105 30 65 15 87 151 151 65 56 1 4 14 50 87 21 11 25 76 191 Digestive 107 18 19 35 4 31 49 58 23 10 1 3 11 16 38 3 6 16 35 5 Urinary 50 15 5 13 0 17 31 10 0 0 0 2 5 13 25 5 5 9 18 18 Generative 14 1 0 7 1 5 .. 14 .. .. .. .. 11 3 .. .. .. 2 4 8 Locomotory 2 1 0 0 0 2 3 .. 1 .. .. .. 1 1 .. .. .. .. 2 1 Integumentary . • • • • • • • • • • • • • • • • • • • • • • • • • • • • .. • • • • • • • • • • IV. Developmental. Premature Birth, Low Vitality 149 50 14 44 5 36 94 55 148 1 .. .. .. .. .. .. 1 13 30 105 Congenital Defects Old Age 103 37 8 20 5 33 33 70 .. .. .. .. .. .. 53 50 12 12 31 48 V. Violence 48 13 9 9 2 15 33 15 14 6 1 1 11 13 2 0 .. 6 4 38 VI. Illdefined & not specified 3 .. .. .. 3 .. 3 .. .. .. .. .. 1 1 .. .. 1 .. • • 5 6 .. 6 •• •• 1 3 3 4 .. .. .. 2 .. .. .. .. .. .. 6 Total 1698 534 182 410 78 494 851 847 429 204 41 49 174 283 409 109 73 196 474 956 11 Causes of Mortality. Table VI. gives us the general summary of all deaths registered within the district and classified according to sex, age and social position. The examination of the details of this table reveals a state of things which must be regarded as highly satisfactory from a Sanitary point of view. (I.) Zymotic Disease. Only 169 deaths from Zymotic disease were registered in the entire district during the year. This is the second annual report of the district since the separation of Battersea. In order to compare these years together, in regard to the prevalence of Zymotic Diseases, the relative numbers for that time are set forth in table VII. Whole District. Clapham. Putney. Streatham. Tooting. Wandsworth. 1888. 1889. 1888. 1880 1888. 1889. 1888. 1889. 1889. 1888. 1889. Total deaths from Zymotic Diseases 304 169 84 66 16 12 77 32 12 127 47 Zymotic Death-rate 2.1 1.1 1.9 1.4 1.0 0.73 1.7 0.8 2.4 3.7 1.3 Death-rate from all Diseases 13.4 11.6 12.4 11.6 11.7 11.1 11.4 0.2 13.1 18.0 11.8 One cannot fail to be struck with the enormous diminution in the mortality arising from this class of diseases. The total number of deaths was not much more than half of those occurring in the previous year. This being the first year in which Tooting stands by itself, it is interesting to note, that its Zymotic and General Deathrate are both higher than those of any other sub-district. 12 By The Poor Law Act 1889, the managers of the Metropolitan Asylums Board are empowered by statute to receive into their hospitals any person, whether pauper or not, who is known to be suffering from Fever, Small-pox or Diphtheria. By another provision they are enabled to allow their carriages to be used as ambulances for the conveyance of persons suffering from any dangerous infectious disorder, to and from places, other than their own hospitals. In examining the Zymotic mortality in detail, it is found that the great diminution of last year has taken place principally in the incidence of Whooping Cough, Measles and Diphtheria. Only 30 deaths from Diphtheria were registered as compared with 53 during the previous year. This diminution is highly satisfactory, and especially when we bear in mind the prevalence of this disease throughout London generally. The excess in the number of deaths from Diphtheria is the most prominent fact brought out by the Registrar General's returns of Zymotic diseases for London. During the year the mortality from all other zymoticdiseaseswasdecidedlyless. This increase in the prevalence and fatality of Diphtheria does not appear to be due to a passing epidemic. During the six preceding years a similar excess was recorded. The increase is not confined to London but is also observed in the 28 great Towns of England and Wales. This would seem to indicate that some more or less permanent cause must be at work. It is of importance to note in connection with this disease that it has been more prevalent in the Sanitary area of Lambeth than in any other district of London. This district touches us on the side of Clapham and it is natural to suppose that this sub-district has thereby suffered more than the other part of the Wandsworth area, 13 2.) motic. Cancerous disease was noticed in last year's report as having been on the increase for several years. During 1889 however there has been an appreciable diminution in the mortality from this disease, but througout London generally another decided increase has been recorded. Infantile Mortality. 429 deaths were registered during the year, of infants under 1 year of age. This was equal to 25.2 per cpnt of the total number of deaths. The infantile mortality is however better expressed in relation to the number of children born within the year. The figures below give us the number of deaths of children under one year of age for every thousand births. Deaths under 1 year per 1,000 births— In Clapham 15.0 ,, Putney 127.6 ,, Streatham 100.9 ,, Tooting 143.8 ,, Wandsworth 91.1 For the entire district the infantile mortality thus expressed is 105. This rate is very low indeed. It is the lowest of all the Sanitary areas of registration into which London is divided. The small proportion of infants who die in this district compared with London generally would seem to indicate that more enlightened ideas prevail here in regard to infant feeding, than in the districts around us. It is a well known fact that improper feeding is one of the most fruitful causes of disease and death among infants during their first year of life. General Rcmarks. The year 1889 has been singularly free from any serious epidemics of Zymotic Disease, thereby giving us an exceedingly low Zymotic Death-Kate. At the same time it has been remarkable for the low deathrate arising from diseases of a non-zymotic character. We have therefore every reason to congratulate ourselves on the sanitary condition of the district as evidenced by these facts. 14 Since our last annual report two highly important and beneficial enactments bearing on the health of the community have been passed by the legislature. These are The Infectious Diseases (Notification) Act 1889 and The Poor Law Act 1889. By the first of these, we have obtained what we have repeatedly before in our annual reports pointed out to be absolutely necessary for the prompt and effectual stamping out of 1 nfectious Disease. We now obtain immediate notification of most infectious diseases which break out in our district. We are thereby put in possession of the knowledge of the existence of such disease and can thereupon take such steps as we deem necessary for preventing the spread of the same. Through the courtesy of the Metropolitan Asylums Board each medical officer is also made cognisant of the prevalence of infectious-disease beyond the borders of this district. This knowledge may at times prove most advantageous in the prevention of disease. According to the terms of the Act each medical officer has on receipt of any notification to send a copy of the same to The Asylums Board Offices. By a resolution of your Board, at the request of the School Board, The Medical Officers also send copies of all notifications of infectious disease within their district to The School Board Superintendent Visitor. Thereupon notices are sent at the instance of the School Board to the houses where infectious disease exists, warning the occupants thereof not to send any of their children to the public school until infection has ceased. These precautions are calculated to prevent to a great extent the spread of infectious diseases, which results from children from infected houses attending crowded public schools 15 These sanitary provisions legally constitute the Metropolitan Asylums Board the central authority for the providing of Hospital accommodation, and for the removal from place to place of all cases of infectious disease. They therefore greatly facilitate the quick removal and isolation of all persons suffering from these disorders. in former years we have been enabled to present in a tabulated form, all those cases of infectious disease which had been removed to hospital. We are unable to do so this year. On account of the changes introduced by the notification act the returns were discontinued. Table VIII. gives us some interesting information in regard to the number of TABLE VIII. SUBDISTRICTS. Number of Births Returned from 1st January to 31st December 1888. Successfully Vaccinated. Insusceptible of Vaccination. Had Small- pox. Dead Unvaccinated. Postponed by Medical Certificate. Removed to Distinct, Vaccination Officer of which has been duly apprised. Removed to places unknown, or which cannot be reached; and cases not having been found. Clapham 1079 854 4 .. 104 33 16 68 Putney 365 305 2 .. 27 5 26 Streatham 1187 945 7 .. 95 37 30 73 Wandsworth 1452 1206 5 .. 117 23 3 98 Totals 4083 3310 18 .. 343 98 49 265 vaccinations performed in this district; 4,083 births were registered during the year 1888. 3,310 were returned as being successfully vaccinated. 205 children were left unaccounted for, which is equivalent to 6.4 per cent. Inquests, etc. It will be seen from Table IX. that 89 inquests were held in this district during the year. This is equivalent to 5.2 per cent of the total deaths registered in the entire district. 16 TABLE IX. Verdicts. Total. Clapham. Putney. Streatham. Tooting. Wandsworth. I. Deaths from Natural Causes: 44 13 6 6 .. 19 II. Deaths from, Violence: .. .. .. .. .. .. (a) Accidental: Overlaying 6 3 .. .. .. 3 Poisoning 5 5 .. .. .. .. Fracture of Skull 2 .. .. 1 .. 1 Suffocation 2 .. 1 .. 1 .. Head injuries 3 .. .. 2 .. 1 Fall from window 1 .. .. 1 .. .. Injuries to Chest 1 .. .. 1 .. .. Burns 1 .. .. 1 .. .. Internal injuries 1 .. .. 1 .. 1 Run over by train 1 .. .. .. .. 1 Scalds 1 .. .. .. .. 2 Drowning 3 .. l .. .. 1 Fractured Ribs .. 1 .. .. .. .. 1 Suffocation by smoke 1 .. .. .. .. .. (1) Suicidal: 2 2 .. .. .. .. Pistol Shot 2 .. .. 1 .. 1 Drowning 3 .. 2 1 .. .. Poisoning 1 .. l .. .. .. (c) Homicidal: Murder 2 1 l .. .. .. Man-Slaughter .. 2 1 .. .. .. 1 Execution 1 .. .. .. .. 1 Open Verdicts: .. Fractured Ribs 1 .. .. .. .. 1 Found Dead 1 .. .. .. .. 1 Found Drowned 1 .. 1 .. .. .. Totals 89 25 13 15 1 35 Sickness among Union Poor. During the year 2,014 cases came under treatment as compared with 1,773 during the previous year. 17 TABLE X. Sickness amongst Union Poor during 1889. 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.—Diarrhoea and Dysentery. 7.—Cholera. 8.—Fever. 9.—Erysipelas. 10.—Puerperal Fever. 11.—Lung Disease, except Phthisis. 12.—Phthisis. 13.—Hydrocephaius, Atrophy Scrofula 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 900 33 .. .. 17 4 1 .. .. .. 8 1 56 6 .. .. 8 .. 6 .. .. .. 192 13 9 1 4 1 3 .. 596 7 Putney 79 11 .. .. 7 .. .. .. .. .. .. .. 6 .. .. .. .. .. .. .. .. .. 17 .. 2 .. 1 .. .. .. 45 .. Streatham 207 6 .. .. .. .. .. .. .. .. 10 1 6 .. .. .. .. .. .. .. .. .. 44 2 4 .. 3 .. 5 .. 135 4 Tooting 106 6 .. .. 14 .. .. .. .. .. 6 .. 5 .. .. .. 2 .. 1 .. .. .. 14 .. .. .. 2 1 .. .. 62 5 Wandsworth 722 27 .. .. 6 2 2 .. .. .. 21 .. 36 1 .. .. 6 .. 6 .. .. .. 175 6 15 2 11 4 4 2 420 12 Total 2014 83 .. .. 44 6 3 .. .. .. 45 2 109 7 .. .. 16 .. 13 .. .. .. 442 21 30 3 21 6 12 2 1258 28 18 Sanitary Operations. The last table gives us in a combined form the total number of the Sanitary Operations carried out within the whole district. There were 18,679 houses and premises inspected during the year. This indicates an enormous amount of useful sanitary work. 2,498 notices were served to remedy defects. These notices were complied with in all cases, to the satisfaction of the Inspectors, except in three instances where compulsory magisterial orders had to be obtained. It is interesting to compare this record with that of ten years ago. In the year 1879, 3,723 houses and premises were inspected and 1,148 notices were served. Although not half the notices were served, as during 1889, compulsory orders had to be obtained in 61 cases. During these ten years therefore wo have made great advance in sanitary matters all along the line. The house to house inspection is being carried out in a more and more thorough and systematic manner. The public generally are also understanding better the great necessity for attending to. those sanitary defects which are pointed out. The officials meet with less obstruction in the performance of their duties. Instead of being regarded as useless intruders, as at one time in many cases they were, they have now the loyal co-operation and assistance of the public in the discharge of their duties. TABLE XI. Summary of Sanitary Operations in the entire Distiiot during the year 1889. Clapham. Putney. Streatham. Tooting. Wandsworth. Total. Number of Houses and ises inspected 5922 3651 4392 337 4395 18697 1st Notices served 1114 435 467 81 401 2498 2nd Notices served 133 156 20 18 42 369 Number of houses disinfected after infectious diseases 84 14 90 5 174 367 Number of houses in which infectious disease recurred after disinfection .. .. .. .. 3 3 Number of houses from which bedding, &c., was burnt 8 .. 6 1 .. 15 Disinfecting apparatus at Putney, number of times used 10 5 .. .. .. 15 Overcrowding abated 5 .. 3 1 2 11 Rooms cleansed and repaired 362 78 142 16 42 640 Staircases & passages cleansed and repaired 85 22 43 4 15 169 New drains and drains relaid 127 124 210 .. ol 303 Number of feet of new sewers and branch drains .. 9941 7826 .. 3411 13352 Drains cleansed and repaired 296 68 157 27 104 652 Syphon traps fixed to drains. 653 87 83 5 .. 828 Sinks altered to discharge outside over gullies 160 88 97 25 9 379 Bath and lavatory wastes altered to discharge outside over gullies 37 32 23 .. .. 92 Rain water pipes disconnected from drains 123 55 85 10 .. 272 Water-closets cleansed and repaired 527 57 103 7 125 819 Water-closets, supply of water laid on to 36 121 34 21 303 515 Urinals cleansed, repaired or water laid on 8 6 11 .. .. 25 Accumulation of manure, &c., removed 34 15 73 2 16 140 Cesspools abolished 2 .. 17 .. 2 21 Dust-bins provided 267 52 56 20 91 486 Stables drained or paved and cleansed 40 8 5 2 9 64 Yards drained or paved and cleansed 169. 88 7 .. 17 281 Unwholesome or dilapidated houses cleansed & repaired .. 4 13 .. .. 17 Leaky house-roofs and gutters repaired 109 18 43 3 30 203 Houses supplied with water 14 2 15 5 21 57 Water-cisterns cleansed covered and repaired 239 59 32 8 97 415 Cistern overflow pipes disconnected from drains 17 3 2 .. .. 22 Wells closed .. .. .. .. .. .. Pig nuisances removed 3 1 4 l 2 11 Unclassified nuisances 280 4 29 7 36 356 Cases investigated by Magistrates .. 3 1 .. 2 6 Compulsory Orders obtained .. .. 1 .. 2 3 Compulsory works obtained .. .. 1 .. 2 3 LOCAL SUMMARIES. 23 CLAPHAM. Population. The population of Clapham I estimate at 45,990 in the middle of 1889, assuming that the increase since 1881 has been the same as that during the previous decade. As we get further away from the last census enumeration however, the estimate becomes less and less reliable, and the above figure is not unlikely to be very different from the actual population. It probably however errs on the side of being too small, as the number of inhabited houses has increased very greatly since 1881. Births and Birth-rate. The number of births registered during the year was 1,121,—565 of boys, and 556 of girls. The annual birth-rate was 24*3, the same as in 1888. Table I. gives the birth and death-rates, with the actual natural increase of the population for the 10 preceding years. T ABLE I. Birth and Death-rates. YEARS. Births. Birth-rate. Deaths from all Causes. Death-rate. Rate of Natural Increase. 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 1889 1,121 24.3 53* 11.6 12.7 Deaths and Death-rate. During the year, 534 deaths, 246 of males, and 288 of females were registered in Clapham. This gives a death-rate of 11.6 per thousand of the estimated population, as compared with 12.4 in the previous year. The death-rate for the whole of London in 1889 was 17.4 Table II. gives particulars as to the number, causes, ages, and social position of those who have died. TABLE II. STATISTICS OF MORTALITY. CLAP HAM. Total Deaths from each Class of Disease, &c., in the Sub-District. Sex. Age Social Position. Population (caucus) 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 -k) 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 Classes, Merchants &c. Middle and Trading Class. Shopmen Clerks. Arc. Industrial and Labouring Classes. Official Population in Middle of 1889 45,990 CAUSES OF DEATH. I. Zymotic Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 11 7 4 1 .. 1 .. .. .. .. .. .. .. 3 8 Scarlet Fever 2 2 .. 1 1 .. .. .. .. .. .. .. .. .. 2 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 4 2 .. .. .. 2 1 1 .. .. .. .. 1 3 Puerperal Fever 2 .. 2 .. .. .. 1 1 .. .. .. .. .. .. 2 Diphtheria 17 11 6 1 11 3 2 .. .. .. .. 1 .. 4 11 Whooping Cough 15 8 7 2 13 .. .. .. .. .. .. .. 2 4 9 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa, Dysentery, and Cholera 11 3 8 9 .. .. .. .. 1 1 .. .. 1 1 9 Other Zymotic Diseases 4 1 3 .. .. .. 1 .. 1 .. .. .. .. .. 4 Totals of Zymotic Class 66 34 32 14 34 6 6 .. 3 1 .. 1 4 13 48 II Constitutional. . 'Gout and Rheumatism 6 1 5 .. .. .. .. 1 3 2 .. 1 2 1 2 Other Constitutional .. .. 13 .. .. .. .. 1 8 11 1 3 1 8 9 Diseases. 2 1 1 1 .. .. .. 1 .. .. .. .. .. 1 1 Tubercular Phthisis 46 29 17 1 .. .. 7 21 12 2 .. .. 8 16 22 Tabes mesa 9 6 3 7 1 .. 1 .. .. .. .. .. .. 5 4 Hydrocephalus .. .. 4 10 .. 1 .. .. .. .. .. .. .. 4 9 Serfula 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. 1 III. Local Nervous 74 28 46 16 4 1 1 .. 11 37 4 4 10 21 33 Circulatory 56 19 37 .. .. .. 2 .. 18 25 5 6 12 15 22 Respiratory 105 45 60 22 25 2 1 7 12 30 6 4 5 29 67 Digestive 18 9 9 2 1 .. .. 1 4 9 1 1 3 6 9 Urinary 15 11 4 .. .. .. 1 .. 4 6 1 2 2 6 1 Generative 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 Locomotory 1 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Iv . Development. Premature Birth and Low Vitality 50 28 22 50 .. .. .. .. .. .. .. .. .. 7 30 Congenital Defects .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Old Age 37 8 29 .. .. .. .. .. .. 19 18 3 5 10 1 V. Violence 13 9 4 6 1 .. .. .. 6 •• .. .. 2 1 1 VI. Ill defined and Not Specified. Ill defined .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Not Specified •• .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 534 246 288 129 71 10 19 44 83 142 36 25 60 143 30 25 Deaths in Outlying' Institutions. Table III. gives the number, ages, and causes of death of persons previously living in Clapham, who have died during the year in Institutions outside the parish. These institutions include the Union Infirmary, General and Special Hospitals, Hospitals of the Metropolitan Asylums Board, County and other Lunatic Asylums. There were 91 such deaths registered, 47 in the Wandsworth and Clapham Union Infirmary, 40 in the General and Special Hospitals, and 4 in the Asylums Board Hospitals. If these are added to the number of deaths occurring in the parish the death-rate becomes 13.5 as compared with 14.9 in 1888. TABLE III. Deaths in Out-lying Institutions. DISEASE. Total. Sex. Age. Institutions. Male. Female. Under 1. 1 to 60. (30 and upwards. Union Infirmary. General & Special Hospitals. Asylum Board Hospitals. Small Pox .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. Diphtheria 6 4 2 .. 6 .. .. 2 4 Enteric Fever .. .. .. .. .. .. .. .. Whooping Cough 2 1 1 1 1 .. 2 .. .. Measles 1 .. 1 0 1 .. .. 1 .. Other Zymotic Diseases 2 .. 2 1 1 .. l 1 .. tubercular Diseases 18 10 8 1 14 3 9 9 .. Cancer 7 2 5 .. 3 4 3 4 .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 8 4 4 l 2 5 5 3 .. Circulatory Diseases 9 1 8 .. 4 5 8 1 .. Nervous Diseases 11 7 4 .. 6 5 5 6 .. Other Diseases 21 8 13 4 9 8 13 8 .. Violence 6 3 3 .. 5 1 1 5 .. Total 91 40 51 8 52 31 47 40 4 26 Ages at Death. Of the total deaths the proportion in age groups was as follows:— Under 5 years 37.5 per cent. From 5 to 60 years 29.2 „ Over 60 years 33.3 „ The infantile death-rate or the proportion of deaths under 1 year to the number of births was 115 per thousand, compared with 150 per thousand in 1888, a decided improvement. Social Position. The proportional number of deaths in the various social grades was as follows:— Nobility and Gentry 25=4.6 per cent. Professional Classes 60=11.2 „ Trading Classes 143=26.8 „ Industrial Classes 306=57.4 „ TABLE IV. Zymotic Mortality in Olapham. 1880 1881 1882 1883 1884 1885 1886 1887 1888 1889 Small-pox 2 7 1 .. 2 .. .. .. .. .. Measles 19 10 15 33 33 3 11 25 14 11 Scarlet Fever 21 15 26 8 3 .. 1 6 5 2 Diphtheria 3 3 4 7 8 4 6 10 16 17 Enteric Fever 4 3 7 3 4 8 3 4 5 4 WhoopingCough 25 13 17 16 15 25 34 25 28 15 Epidemic Diarrhœa 36 20 4 19 18 16 25 24 15 11 Other Zymotic Diseases 9 7 7 26 12 5 4 6 1 4 Total deaths from Zymotic Diseases 119 78 81 112 95 61 84 100 84 66 Zymotic Deathrate 3.4 2.1 2.1 2.9 2.3 1.49 2.0 2.2 1.9 1.4 Death-rate from all Diseases 14.9 13.5 14.5 15.1 13.7 12.4 12.9 13.93 12.4 l1.6 27 Zymotic Diseases. Table IV. gives the number of deatlis from these diseases as compared with previous years and a comparison of Zymotic and general death-rates. The Zymotic death-rate was 1.4 per thousand of the estimated population, the lowest rate in the ten years. If we include the 11 deatlis of this class that occurred in out-lying institutions, the Zymotic rate becomes l.67 per thousand. The number of deaths in all the different classes has decreased and was less than the average, excepting in the ease of diphtheria which was above the average. Small Pox.—No case has come under notice during the year. Diphtheria.—During the year there Were 17 deaths from this disease in the Parish and 6 in out-lying institutions, this same number as in 1888. The decennial average is 6.7. Altogether 62 cases came to our knowledge. They occurred in nearly every part of the district, but were especially numerous in a comparatively small area consisting of Lyham Road and the streets opening out of it, in which we knew of 34 cases with 15 deaths, out of the total of 23. I had last year to report that in this area there was a greater amount of the disease than in other parts of the parish. In seeking an explanation for this, it must be remembered that the Lyham Road is the boundary between Clapham and Lambeth, one side being in one parish and the opposite in the other. This renders the tracing of the causation of individual cases a matter of extreme difficulty and the fact that the children play together in the street to a great extent, makes direct infection very probable. There was during the year, I am informed, a considerable amount of diphtheria in the contigous part of Lambeth. 28 There are however other facts which bear on the prevalence of diphtheria. Out of the 34 cases no less than 22 occurred in houses the children from which attended the Board School in Lyham Road. The School was found to be in a defective sanitary condition, and was closed for some weeks and put into repair during the middle of the summer. Cases continued to occur, however, after the re-opening, when the school was presumably in proper condition. This shows, I think, that the cause was not drain poisoning in the school, but was, in the later cases at all events, spread by some child or children carrying infection there, which the conditions obtaining in a school room render very likely to happen. Many of the cases only came to my knowledge several weeks after their occurence, and assuming that the teachers were also ignorant of them it is highly probable that the proper precaution of a sufficiently long absence was uot insisted on. All the houses in which diphtheria occurred were carefully inspected, and the drains tested by forcing smoke into them. In 31 houses some defect was found and remedied, but the defects were nearly all of a slight character, such as a dirty cistern, or defective fittings of outside water-closet. All the houses in the special area above referred to were inspected, not only those in which cases were known to have occurred. There is no possibility of attributing the diphtheria to milk as there was a great variety of supply. Scarlet Fever. Only 2 deaths were due to this disease and none at all in out-lying institutions. Considering that 63 cases came under notice during the year, it will be seen that the disease was of a very mild type. During 1888 there were fifteen deaths. The deaths were below decennial average, which is 8-7. 29 Enteric Fever.—There were 4 deaths from this cause, 14 cases being reported. The decennial average is 5. Whooping Cough and Measles were the cause of 26 deaths. This is considerably less than the decennial average which is 403. Nevertheless the mortality from these diseases compares very badly with that from Scarlet Fever or any of the other Zymotic diseases. Parents require to be impressed with the fact that these are preventable diseases and until that is more widely recognised all attempts to isolate will, as now, continue to be neglected. Diarrhoea was the cause of only 11 deaths the decennial average being 19.4. Notification of Infectious Diseases.—The most important event of the year was the passing of the Act for this purpose, which came into force in the end of October. It will be of the greatest value in preventing the spread of disease, but at present the time is too short to enable us to speak with experience of its benefits. Medical practitioners have loyally carried out its provisions, but notification by householders has almost entirely been neglected. Disinfection. Rooms in 84 houses were disinfected after Zymotic disease by means of Sulphurous Acid. Besides this, the bedding, hangings, etc. have been disinfected by heat in those cases where the patients were not immediately removed to the hospitals. The sum of £19 7s. 3d. has been expended for this purpose in cases where the the persons were too poor to pay for it themselves. The sum of £12 17s. 6d. was spent for the like purpose in 1888. 30 Inquests. Twenty-five inquests were hold during the the year, and the following verdicts returned:— 1. From Natural Causes 8 2. Accidental—Children suffocated in bed 3 Poisoning 5—8 3.Suicide 2 4. Homicide—Manslaughter 1 Murder 1—2 25 Uncertified Deaths. Six deaths were registered on letters from the coroner. Sanitary Proceedings „ During the year 5,922 houses and premises of the year, have been inspected. The total number of nuisances dealt with amounted to 3,293, of which 2,705 were abated on notices being served, 508 without. There were 1,114 first notices and 133 second notices served, to remedy sanitary defects and abate nuisances, and in 8 cases it was found necessary to obtain orders of the Board: Table XI. page 19 gives a statement of the nuisances that can be conveniently classified. Besides these there were 280 as follows:—06 new ventilating pipes, 12 ventilating pipes repaired, 15 soil-pipes repaired, 47 leaky water fittings, 8 water butts repitched, 2 water-closets ventilated, 5 floors ventilated, 9 ca-es of water in basements, 34 bake-houses required limewhiting, 11 manure pits repaired or reconstructed, 4 privies abolised, 7 cases of stagnant water, 6 cellar dwellings, 2 areas cleansed, 4 cases of foul matter removed from under floors, 2 foul earth closets cleansed, 11 cases of throwing slops down public gullies, 3 complaints of rats, 3 cases of burning clay, 2 complaints of smoke from workshops, leaky bath, water-butt replaced by cistern, 31 foul bedding destroyed, carpet beating, confectionery being manufactured in a stable, defective grease trap, horse kept in dwelling house; animals kept so as to be a nuisance, 4 cases of rabbits, 5 of fowls 2 of pigeons, 1 of ducks. Police summons were obtained in 4 cases of non-compliance with notices to abate nuisances, and in each case the defendants agreed to carry out the necessary works without going before the magistrate. A quantity of unsound oranges and apples was seized and ordered to be destroyed by the magistrate, the owner beiue- fined £5 The Cow-houses and Slaughter-houses were inspected in October, and their sanitary condition found satisfactory The Bake-houses have been inspected twice during the year. Limewhiting was required in 13 instances in April, and in 21 in October, and in all cases this was promptly done. The above statements show that the sanitary work of the parish is being energetically carried on, and that in the year 1889, the Public Health was more satisfactory than in its predesessors. In conclusion I beg to thank our Surveyor, Mr. Southam, for the ready help he has given me on every occasion, and to express my satisfaction with the thoroughness and ability with which the Head Inspector, Mr. Fail-child, has discharged his duties. OLIVER FIELD, M.D. Medical Officer of Health for Cluphum, 32 PUTNEY & ROEHAMPTON. Population. In the middle of the year 1880 the population of this sub-district was estimated to be 10,330. This estimate was arrived at in the ordinary way by adding the estimated increase to the actual population existing at the last census. Births and Birth-rate. During the year 376 births were registered, 202 males and 174 females. This gives a birthrate of 23.0 per thousand per annum, which is a slight increase on that of the previous year. Our birth-rate therefore keeps very low. Throughout the whole of London the birth-rate was 30.3 per 1,000 inhabitants. TABLE I Birth and Death Rates. YEARS. Births. Birth-rate. Deaths from all Causes. Death-rate. Rate of Natural, Increase. 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 ll.8 11.2 1887 349 22.3 196 12.5 9.8 1888 366 22.9 187 11.7 11.2 1889 376 23.0 182 111 11 9 Deaths and Death-rate 182 deaths were registered during the year, 85 males and 97 females. The death-rate was 11.1. This is the lowest record for this parish, 33 Deaths in Out-lying Institutions. Besides those deatlis registered within the parish I present in a tabular form all those deaths of inhabitants of this sub-district, which have taken place in out-lying public institutions. TABLE II. DISEASES. Total Sex. Age. Institutions, Males. Female. Under 1. 1 to 60. 60 and upwards. tTnion Infirmary. Gencralv&; Special Hospitals. Asylum Board Hospitals. Small Pox .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. Diphtheria 2 1 1 .. 2 .. .. 2 .. Enteric Fever .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases .. .. .. .. .. .. .. .. .. tubercular Diseases 1 1 .. .. 1 .. .. 1 .. Cancer 1 .. 1 .. .. 1 .. 1 .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 7 2 5 .. 4 3 4 3 .. Circulatory Diseases 5 2 3 .. 2 3 2 3 .. Nervous Diseases 1 .. 1 .. .. 1 1 .. .. Other Diseases 10 5 5 2 4 4 4 6 .. Violence 1 1 .. .. 1 .. .. 1 .. Totals 28 12 16 2 14 12 11 17 .. The number of such deaths is slightly below that of the preceding year. If these be added to those registered within the district, it gives us a death-rate of 12.8 per thousand as compared with 13.5 for the previous year, and 14.3 in the year 1887. General tality in Putney and Roehampton. In Table III. all deaths registered in the sub-district are recorded and classified according to the cause, under the heading of ago, sex, and social position. TABLE III. PUTNEY. Total Deaths from each Class of Disease. Sex. Age. Social Positioii Males. Females Under 1 Year. From 1 to 5. years. From fi 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. Population (Census) 1881 13,221 Official Population in middle of 1889 16,330 CAUSES OF DEATH. I. Zymotic. Small-pox Measles 2 2 .. i i Scarlet Fever 1 i i Typhus Fever Enteric Fever 1 i 1 i Puerperal Fever Diphtheria Whooping Cough 6 1 5 4 2 1 i Erysipelas 2 1 1 i i 1 1 Diarrhœa, Dysentery & Cholera Other Zymotic Diseases Totals of Zymotic Class 12 4 8 6 3 1 i i .. • • ., 3 9 II. Constitutional. Gout & Rheumatism Cancer & other Tumours 6 , , 6 1 4 i i I Other Constitutional Diseases 1 1 1 1 1' 1 l£ Phthisis 17 7 10 1 1 1 4 6 2 2 4 4 k Tabes Messenterica 3 3 3 Hydrocephalus 2 4 1 2 1 1 Scrofula III. Local. f Nervous 32 13 19 4 5 2 1 1 8 7 4 4 16 [ Circulatory 17 8 9 1 1 4 fi 3 3 3 3 j Respiratory 30 lfi 14 fi fi 1 1 7 R 1, 5 i i Digestive 19 9 10 7 3 ?, f, 1 4 1 5 1_ rinary 5 3 2 1 3 1 4 Generative Locomotory w Integumentary IV. Developmental. Premature Birth and Low Vitality 12 9 3 12 2 1 Congenital Defects .... 2 2 2 1 , Old Age 8 8 3 3 .. ., 4 V. Violence 9 4 5 2 1 1 3 1 1 , , ,, 2 # # V I. Illdefined and f Illde fined .. Not Specified ( Not Specified 5 3 2 3 2 .. Totals 182 85 97 48 20 5 9 10 33 35 13 2 20 43 35 Zymotic Mortality. Only 12 deaths were registered under this class of diseases, and of these 6 were the result of whooping cough, no doubt aggravated by complication This gives us the exceedingly low death-rate from Zymotic diseases of .73. Only one death has occurred frum Scarlet Fever. Since the great epidemic wave of Scarlet Fever which passed over London in 1887, the type of this disease has been as a rule a very mild one. Asaresult of this the mortality bears a smaller pioportion to the total number of cases. In my last year's report I mentioned that in endeavouring to stamp out this disease, we required, 1st Notification of all cases, and secondly more compulsory powers for removal to hospital of those cases where efficient isolation could not be obtained m their own houses. It is so far satisfactory that the first step has been taken, and undoubtless we shall obtain in a short time the full powers of compulsory removal in cases where it is necessary. The operation of the Compulsory Notification Act and the Poor Law Act, 1889, is referred to in the General Summary. TABLE. IV. Zymotic Mortality in Putney & Roehampton Sub-ths'rict ZyMjtic Mortality. 1880 1881 1882 1883 1884 1885 1886 1887 1 b88 1889 Erysipelas .. .. .. .. .. .. .. .. .. 2 Small Fox .. .. .. .. 1 .. .. .. .. .. Measles .. 6 13 2 1 4 4 2 .. 2 Scarlet Fever 1 8 4 7 .. .. 1 1 .. 1 Enteric Fever 4 1 4 2 10 3 1 .. 2 1 Diphtheria .. 1 29 24 .. 5 1 1 2 .. Whooping Cough 9 3 8 2 8 1 18 2 6 6 Epidemic Diarrhoea 10 3 5 5 8 4 9 .. 4 .. Other Zymotic Diseases 1 5 6 2 .. 1 8 1 2 .. Total Deaths lrom Zymotic Diseases 25 27 69 44 28 18 38 7 16 12 Zy motic Death-rate 1.9 2.0 2.0 3.1 1.9 l.1 2.49 0.44 1.0 0.73 Death-rate for all Diseases 13.6 12.5 1.51 1.71 13.7 11-2 11.8 12.5 11.7 11.1 36 Infantile Mortality. No less than 48 deatli? out of the total of 182 occurred among infants during the first year of life. For every 1,000 children born within the year, there were 127 deaths. In other words, for every eight childien born, one died during the first year of life. This mortality, although certainly higher than it should be, is low when compared with that of the 28 great towns of England and Wales. The average for these towns during 1889, was 161 deaths for every 1,000 births. In examining the causes of this mortality, one might say that one-third of these deaths has been due to preventiblo causes, and of these causes the most important is want of care and knowledge in infant feeding and hygiene. Eight deaths were due to old age and they were all deaths of females. Six deaths were due to Canccrous disease and they all occurred among females only. Social Position of diseases. The relative mortality as classified according to social statistics, is as follows:— Nobility and Gentry 2=1.1 per cent. Professional 20 = 10.9 ,, Middle and Trading 45 = 24 .8 „ Industrial and Labouring 115 63.2 „ The industrial classes therefore yield a higher percentage of the total deaths than in the previous year. The fact which I pointed out before is again noticeable, namely: that while the working classes yield 63.2 percent of the total deaths, they yield a higher proportion of the deaths from Zymotic diseases. Inquests and Uncertified Deaths. During the year 13 inquests were held, and the lesults are tabulated below. Deaths from Natural Causes 5 ,, Violonce (a) Accidental 3 (b) Suicidal 3 (c) Homicidal 1 Open Verdict—Found Drowned 1 37 Sanitary Proceedings. Table XT. in the Summary gives the usual information in regard to the different kinds of sanitary work carried on during the year, i here has been a great increase in the amount of work done as compared with the preceding year. 3,651 houses were inspected as compared with 2,686 during the year 1888. 14 houses were disinfected after infectious diseases, and in no case did the disease recur after disinfection. All the Sanitary work was carried out without the necessity of compulsory magisterial orders. House Refuse. The disposal of house refuse is becoming every year a more pressing question in ban neighbourhoods. Hitherto authorities have in most cases been satisfied if they have been able, economically, to have it carted away and deposited beyond their own borders, regardless of the nuisance it may possibly create to their immediate neighbours. We have ourselves suffered from the operation of this primitive plan. The time has come when greater care ought to be exercised in this respect. Two reasonable plans suggested themselves for the solution of the question : I. The destruction by fire of all the organic and injurious part of the refuse. II. The deposit of it upon some piece of land cured for the purpose, and sufficiently removed from all inhabited districts, to be no nuisance or source of danger. The first is doubtless the more scientific nnthod, but there are many practical difficulties to be got over in the carrying of it out in practice. The best method may vary with different districts, depending upon the situation of the district, the density and extent of the population, and the facilities at hand for the disposal of the refuse. I understand Kensington Vestry has bough!: a piece of 38 land lowards tlie tnouth of the river, to be utilised for this purpose. The position of this sub-district along the banks of the river suggests that a similar place might be found, most expedient for ourselves. For several years past our own refuse has been deposited within the sub-district, on a piece of land adjoining the river. Within the last eighteen months dwelling houses have begun to be erected in the vicinity, and it will very soon become absolutely necessary to find other means for the disposal of the refuse. Vaccination. During 1888, out of 365 Birth returns, 305 wt re successfully Aaccmated. 2 were found insusceptible ol vaccination, 5 were postponed by medical certificate, 26 removed to places unknown, and 27 died unvacccinated. Sickness among the Parochial Poor The table given with the general summary reveals the extent of sickness which existed among the parochial poor during the year. The utual inspection of the Cow-hou?es and Slaughterhouses were made and their condition reported on, before the renewal of their licenses. The bake-houses also underwent the usual inspection and were found satisfactory. All the facts and figures collected and tabulated above, go to show that the Sanitary state of the Parish still lemains eminently satisfactory. The year has been an exceptional one for its low death-rates and for the freedom we have enjoyed fiom epidemics of an Infectious nature. 1 Lave again much pleasure in thanking Mr. Radford for his assistance whenever required, and to bear witness to the smooth and efficient manner in which all sanitary wovk connected with the parish is carried out. Wm. Y. ORR, Medical Officer of Health for Putney $ Rwhatnpton. 39 STBEATHAM. I have the pleasure to announce that the public health in Streatham attained a high standard in the year 1889. The following statistics will I believe confirm this statement, they relate exclusively to Streatham ; those who may wish to compare the figures given in the several tables for this year, with those of former years, must add thereto the figures given in the summary for Tooting. Vital Statistics. Population. I estimate the population of Streatham at 40,000 persons living in the middle of the year 1889. This assumes there was an increase of the population in the same ratio as obtained in the inter-census decennium 1871—1881 on the enumerated population of the latter year. That the population really exceeds this estimate there is very little doubt. Mr. Bellamy, the Clerk to the Vestry, informs me that there are 7,212 occupied houses in the parish, this at the moderate computation of six persons per house (for the last 20 years there have been upwards of six per house) would give a population of over 42,000 persons. The census of next year will clear up any doubt on this score. Meanwhile I do not overstate the case in placing tl>3 population at 40,000 in the middle of the year 1889. 40 Births and Birth.rate. The number of births registered during the year was 1,020, 536 of males and 484 of females. The birth.rate calculated from the total number of births and the foregoing estimate of the population was 25'5 per 1,000 persons living during the year. The number of births is nearly double that of 1879. Natural Increase. The rate of natural increase is represented by the excess of births over deaths and is 15.2 per 1,000 of the population. Deaths and Death.rate. There were registered in this sub.district 410 deaths during the year 1889, of these seven were of parishoners of St. Pan eras in St. Ann's Home. The death.rate including these was 10.2 per 1,000, without them 10'1, this is the lowest death.rate I have ever yet had to record. When to these deaths are added those of persons who died in various out.lying general and special hospitals the death.rate is raised to 11.2 per 1,000. TABLE I. Birth and Death Rates. YEARS. Births. Birth-rate. Deaths from all Causes. Death-rate. Rate of Natural Increase. 1879 636 34.4 290 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 1881 1,138 39.2 445 15.3 23.9 1885 1,078 35.6 423 13. 9 23.6 1880 1,078 34.3 473 15.0 19.2 1887 1,185 30.0 445 11.6 19.1 1888 1,184 26.3 515 11.4 14.8 1889 1,020 25.5 410 10.2 15.2 41 The deaths that took place in out-lying general and special hospitals are given in the following table which shows the nature of the cause of death, the age and sex of the deceased and the character of the institution in which they died. TABLE II. Deaths in Out-lying 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 .. .. .. .. .. .. .. .. .. Scarter Fever 4 1 3 3 .. 1 3 Diphtheria .. .. .. .. .. .. .. .. .. Enteric Fever 1 1 .. .. 1 .. .. 1 .. Whooping Cough .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Other Zymotic Diseases 2 2 .. .. 2 .. .. 2 .. Tubercular Diseases 6 4 2 .. 6 .. 1 5 .. Cancer 3 2 1 .. 1 2 .. 3 .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 2 2 .. .. .. 2 1 1 .. Circulatory Diseases 3 .. 3 .. 2 1 l 2 .. Nervous Diseases 7 3 4 .. 6 1 1 6 .. Other Diseases 9 3 6 .. 4 3 5 4 .. Violence 5 4 1 .. 5 .. .. 5 .. Totals 42 22 20 3 30 9 9 30 There was a total of 42 deaths in extra parochial institutions, 22 of these were of males and 20 of females, 9 took place in the Union Infirmary, 30 in general and special hospitals, and 3 in the Asylums Board Hospitals. When these 42 deaths are added to the 410, that occurred in Streatham, the death-rate is raised to 11.2 per 1,000 of the population, this rate cannot be held to be correct, as it includes the deaths of non-parishoners who TABLE III. STATISTICS OF MORTALITY. STREATHAM. Total deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Population (Census) 21,607 1881 Males. Females Under 1 year. From 1 to 5 years. From 5 to in 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 Classes. Official Population in 40,000 middle of 1889 CAUSES OF DEATH. I. Zymotic. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 5 .. 5 1 4 .. .. .. .. .. .. .. 1 .. 4 Scarlet Fever 1 1 .. .. 1 .. .. .. .. .. .. .. .. • • .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 6 3 3 .. 5 .. .. 1 .. .. .. .. 1 1 4 Whooping Cough 9 5 4 3 6 .. .. .. .. .. .. .. 3 3 3 Erysipelas 1 .. 1 .. .. .. .. .. .. 1 .. .. .. .. 1 Diarrhoea, Dy. entry, and Cholera. 8 5 3 8 .. .. .. .. .. .. .. .. 1 4 3 Other Zymotic Diseases. 1 .. 1 .. .. .. .. .. 1 .. .. .. 1 .. .. Totals of Zymotic Class 32 15 17 12 16 .. .. 2 1 1 .. .. 7 9 16 II Constitutional. Gout and Rheumatism 3 2 1 .. .. 1 .. .. 1 1 .. .. .. 2 1 Cancer & other Tumours 18 6 12 .. .. .. 1 1 4 11 1 .. 7 5 6 Other Constitutional Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tubercular Phthisis 96 15 11 .. .. 1 l 11 10 3 .. 2 7 8 9 Tabes Mesa 9 6 3 3 5 1 .. .. .. .. .. .. 1 3 5 Hydrocephalus 11 9 2 3 6 2 .. .. .. .. .. .. .. 4 1 Scrofula 4 3 1 .. 3 .. .. .. 1 .. .. 1 .. 3 .. < III. Local. Nervous 77 44 33 24 6 2 2 4 10 25 4 6 11 30 30 Circulatory 37 18 19 .. .. 2 .. 5 10 18 2 4 7 15 11 Respiratory fin 4° 23 12 7 .. .. 1 12 25 8 3 11 23 28 Digestive 35 16 19 4 5 2 1 3 6 14 .. 3 .. 14 12 Urinary 13 9 4 .. .. .. .. 2 2 6 3 2 4 4 .. Generative 7 .. 7 .. .. .. .. 6 1 .. .. .. .. 3 2 Locomotory .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumenrtary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. IV. Developmental. Premature Birth and Low Vitality 44 27 17 43 1 .. .. .. .. .. .. 1 4 14 25 Congenital Defects Old Age 20 9 11 .. .. .. .. .. .. 9 11 5 .. 5 5 V. Violence 9 7 2 2 1 .. .. 2 4 .. .. .. 1 1 7 VI. Illdefined and Illdefined . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Not Specified Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 110 228 182 103 50 11 5 37 62 113 29 27 73 143 167 43 died within the sub-district, of the number of these there is no record, but there is reason to believe they nearly balance the extra parochial deaths, so that 10.2 may be safely accepted as the death-rate of Streatham for 1889. Infantile Death-kate. That is to say the number of deaths of infants under one year of age per 1,000 of the registered births. This year the infantile death-rate was 100'9 per 1,000 births, as compared with 141 in London generally. Social Tosition. The subjoined table gives the percentage of deaths from all causes in the several social grades during the year. Nobility and Gentry 27 = 66 per cent. Professional Classes 73 = 17.8 ,, Middle and Trading Classes 143 = 34.9 ,, Industrial and Labouring Classes 167 = 40.7 „ Total deaths 410 100.0 There was an increase in the Professional and Trading and a decline in the Higher and Labouring Classes. Zymotic Diseases, their prevalence and fat ality There were 32 deaths in this class. Tliey yield a percentage of 7 8 upon the deaths from all causes during the year and give a deathrate of 0 8 of the population. 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. 44 TABLE IV. Zymotic Mortality in the Streatham Sub-district. 1879 1880 1881 1882 1883 1884 1885 1886 1887 1888 1889 .. .. .. .. .. .. .. .. .. .. .. Measles 2 1 3 5 7 8 2 11 21 .. 5 Scarlet Fever 5 31 13 9 2 8 .. .. 4 5 1 Diphtheria 2 7 1 4 13 3 5 6 7 30 6 Enteric Fever 3 5 2 9 8 4 6 3 2 1 1 Typhus Fever .. .. .. .. .. .. .. .. 1 .. .. Whooping Cough 21 8 9 1 11 9 7 26 6 22 9 Epidemic Diarrhoea 3 6 9 3 9 11 12 20 16 13 8 Other Zymotic Diseases 10 10 9 10 15 11 2 1 7 3 2 Total deaths from Zymotic Diseases 46 68 46 41 65 54 31 67 64 77 32 Zymotic Deathrate. 2.2 2.7 1.7 1.6 23 1 8 1.1 2.1 1.6 1.7 0.8 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 10.2 On referrence to the Table it will be seen that there was no death from small-pox, nor was any case notified during the year as occurring in Streatham. London as a whole appears to have en j oy ed almost a 1 otal immunity from the disease. The Report of the Chairman to the Asylums Board states that "Only 5 cases were received into the Board's Hospital Ships at Long Reach during 1889, which shows that the Metropolis enjoyed special immunity from the disease, an immmunity which may be again ascribed to prompt notification of the cases to the Medical Officers of Health for the Districts from which the patients were removed and to their immediate removal to, and isolation at Long Reach." It was only in the Autumn that the conpulsory notification of Infectious Diseases Act came into operation, this very important measure of sanitary legislation must exert 45 a powerful preventive influence on infectious diseases. Through notification the Medical Officer of 1 Iealth learns from day today the progress of Infectious Disease in his District and can take prompt measures accordingly; he must therefore welcome it as an additional help in the cxercise of his duties. Turning again to the table it will be seen that there was a decline in the number of deaths under all but one heading, and this was precisely the same as last year. Scarlet Fever.—Contributed one death only, but 46 cases of the disease were removed to hospital, where 3 died. There was an increase in the number of cases of Scarlet Fever of a generally mild type during the year, as compared with the year before, and this was also the case in the Metropolis generally. Diphtheria.—Caused six deaths, thirteen cases of the disease came to our knowledge during the year, 3 of these were imported, the remainder were distributed north, south, east and west over the sub-district. Enteric Fever.—Caused one death. The mortality from Whooping Cough, Measles and Diarrhoea, was below the average. Tlic mortality from Zymotic Diseases was very low and their prevalence comparatively slight. otfier Diseases. These are grouped under five heads in the Mortality Table.The percentage which several of the diseases under these heads formed of the total deaths is as follows :— 46 Class II. Constitutional—Tubercular 12.1, Cancer4.0., Class III. Local—Respiratory 15.8, Circulatory 9.0. Nervous 18.7, Digestive 8.5. Class TV. Developmental—Premature birth and low vitality 10.7, Old age 4.8. There was a decline in the percentage of deaths from respiratory, circulatory and nervous diseases and in cancer. An increase in Tubercular diseases and a slight increase under premature birth and low vitality. Age at death. Infant Mortality The number of deaths of infants under one year was 25.1 per cent of all deaths, 37.3 per cent took place before the age of five and 41.2 before the age of 20. There was an increase in the mortality from Tubercular diseases in early life, and a large decrease in respiratory and nervous diseases. Senile Mortality. Twenty deaths are ascribed simply to old age, 9 of males and 11 of females, 142 deaths occurred at and over 60, of these 41 ranged from 70 to 80, 25 were 80 and upwards, and 3 were over 90. Parish Poor. fhe figures relating to the sickness and mortality amongst the parish poor will be found in table X., they show very favourably as regards the amount of sickness from both general and zymotic diseases as well as in the mortality from all causes. It is not now necessary that every case of infectious disease should be seen by the District Medical Officer before being removed to hospital, so that all cases sent to hospitals do not appear in the table. inquests. Fifteen inquests were held with the following results;— 47 I. Natural Heart Disease 3 Convulsions 3-6 II. Accidental Fracture of Skull, found dead on railway 1 Injuries to head from goods train 1 Internal injuries, knocked down and trodden on by a horse 1 Fracture of skull, fall from window 1 Concussion of brain from fall 1 Injuries to chest 1 Burns by hot poker 1—7 III. Suicidal Injury to brain, pistol shot 1 Drowning 1—2 1 5 Uncertified Deaths. Probably Convulsions 2 ,, Syncope 1 „ Epilepsy 1 ,, Peritonitis 1 ,, Diarrhoea 1 ,, Senile Decay 2 „ Rupture cf blood vessel 1 ,, Marasmus 1 10 It is in contemplation I believe to provide a mortuary for Streatham as soon as a suitable site can be found. The present arrangements in case of sudden death from natural or accidental causes are very unseemly, the body is taken to the nearest public house there to await an inquest, and should the Coroner order a post mortem examination it has to be carried out under difficulties ; this plan ought to give place to one more decent and orderly, and a mortuary answers to this description, it might fulfil moreover another requirement, viz :—that of a receptacle for the bodies of those who have died of contagious diseases. Some years ago I recommended a mortuary but the site then thought of could not be obtained. sanitary A summary of the usual and principal sani- Proceedings. tary works of the year may be seen in table XI. which shows that a large amount of work has been 48 accomplished. The number of houses and premises that have been inspected exceed that of the previous year. The value of such work cannot be over-rated, leading as it must do to the detection and remedying of sanitary defects, and not only improving the health but also the moral tone of the people. The work of house to house inspection is I believe carried out very thoroughly by our Inspectors, Messrs. Phimister and Jones. The fumigation and disinfection of houses after infectious diseases is carried out by Mr. Phimister under my directions, in a very complete manner, 73 houses have been disinfected and cleansed, 55 after Scarlet Fever, 13 after Diphtheria, and 4 after Typhoid Fever, in no case has there been a recurrence of the disease. It is hardly necessary for me to enumerate here the many other important sanitary works exhibited in the Table which will naturally claim the attention of all interested in the subj ect. Almost all the notices served requiring people to remedy defects, or abate nuisances were at once complied with ; only 11 requiring a second notice, and only in one case was it necessary to get the order of a magistrate to abate a nuisance, which arose from a deposit of house refuse on the detached portion of Streatham. The bake-houses have all been regularly inspected and are in good condition. I personally inspected all the cow-sheds and slaughterhouses. In two instances, one for renewal and one for new premises, I found it necessary to object to the owners licenses being renewed; these were not granted ; all the others were renewed. F. F. SUTTON, M.D., Medical Officer of Health for Streatham. 49 TOOTING. Owing to tlic past year being the first (luring which the two parishes of Streatham and Tootiug—hitherto included in a joint annual report—have been separated into different sub-districts the following report is of necessity of a somewhat more incomplete nature than in future years I trust it will be. According to the official method the population of Tooting for the year 1889 is 5,187. There is little doubt however, that this is below the actual number of inhabitants, as during the past year or two there has been a very considerable influx of persons in newly built houses. Births, Birth-rate and Rate of Natural Increase. The number of births registered during the year was 146,—79 males and 67 females. The birth rate was 24.33 per 1,000 of the estimated population. The excess of births over deaths, or the rate of natural increase was 11.17 per 1000. Deaths and Death-rate. During the year 78 deaths were recorded in Tooting; 50 of males and 28 of females. The annual death-rate was 13 T6 Thirteen deaths took place in outlying institutions during the year. Of these 8 were males and 5 females. Four took place in the Union infirmary and the remaining 9 in General Hospitals. The accompanying table 1 gives details of the deaths occuiing in outlying institutions with their causes, sex aud age. It may be of interest to state that one of these deaths was that of a female aged 13 years who succumbed from the effects of a bite from a rabid dog which produced hydrophobia. The father and brother of the do- 50 Ceased Were also attacked and s&Verly injured. They were sent to Paris and placid under the charge of Mr. Pasteur and since their return, now some months ago, have remained free from all unfavourable syptoms. TABLE I. 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 .. .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. Enteric Fe^er .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. Measles 1 1 .. .. .. 1 .. 1 .. Other Zymotic Diseases .. .. .. .. .. .. .. .. .. Tubercular Diseases 2 1 1 1 1 .. .. 2 .. Cancer 1 1 .. .. 1 .. .. 1 .. Rheumatism .. .. .. .. .. .. .. .. .. Respiratory Diseases 2 2 .. .. 2 .. .. 2 .. Circulatory Diseases 4 2 2 .. 3 1 2 2 .. Nervous Diseases 1 . . 1 .. 1 .. .. 1 .. Other Diseases 2 1 1 .. 1 1 2 .. .. Violence .. .. .. .. .. .. .. .. .. Totals 13 8 5 1 9 3 4 9 .. Deaths occuring in Tooting. In table II all deaths recorded in Tooting are stated according to sex, age, and social position with the causes of death. Twenty one deaths occurred in infants under one year of age, 20 over 60 years, and 7 from 80 years and upwards. Four deaths occurred amongst ttie gentry, 7 in the professional and mercantile classes, 29 in the middle and trading class, and 38 in the labouring population. Of five deaths 2 took place at 80 years of age, 1 at 84 years, 1 at 85, and 1 at 90 years of age. TABLE II TOOTING. Total Deaths from each Class of Disease, 1 &c., in the Sub-District. Sex. Age. Social Position. Males. Females. 1 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 & Labouring Classes. Population (Census) ) 4,851 1881 Official Population in ) 5,137 middle of 1889 CAUSES OF DEATH. I. Zymotic. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. 3 1 .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 1 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. Typhuus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. Diptheria 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea, Dysentery, and Cholera 1 1 .. 1 .. .. .. .. .. .. .. .. .. .. 1 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... Totals of Zymotic Class 12 .. .. 4 6 2 .. .. .. .. .. .. .. 7 5 11. Constitutional. Gout and Rheumatism 1 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 Cancer & other Tumours .. .. .. .. .. .. .. .. .. 2 .. 1 .. .. 1 Other Constitutional Diseases .. 3 2 1 .. .. .. .. 2 1 1 .. .. 2 3 Tubercular Phthisis .. 2 1 .. .. .. .. 3 .. .. .. .. 1 2 .. Tabes Messenteric .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Hydrocephalus 1 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. Scrofula .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. III. Local. Nervous 9 .. 4 4 2 .. 1 .. .. 2 .. .. .. 3 6 Circulatory 10 7 3 .. .. .. .. 1 3 6 .. .. 4 4 2 Respiratory 15 7 8 2 2 1 .. 1 .. 7 2 1 .. 5 9 Digestive 4 3 1 3 .. .. .. 1 .. .. .. .. 2 2 .. Urinary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Generative 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. Locomotory .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. lV. Developmental. Premautre Birth and Low Vitaly .. 4 1 5 .. .. .. .. .. .. .. .. .. 2 3 Congenital Defects .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. old Age 5 2 3 .. .. .. .. .. .. 1 4 1 .. .. 4 V. Violence .. 1 1 1 .. .. .. .. .. 1 .. .. .. 1 1 VI. Illdefined and ( Illdefined 3 3 .. 1 .. .. .. 1 1 .. .. 1 .. .. 2 Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 78 50 23 21 10 4 1 7 8 20 7 4 7 29 38 52 TABLE 111. Zymotic Mortality in the Tooting Sub-district. 1889 bmail-pox .. Measles 6 Scarlet Fever 1 Typhus Fever .. Enteric Fever .. Whooping-Cough 3 Epidemic Diarrhoea 1 Other Zymotic Diseases 1 Total Deaths from - Zymotic Diseases 12 Zymotic Death-rate 2.4 Death-rate from all Diseases 13.16 Zymotic MorUiliy. In table III we liave the number and causes of death from Zymotic Disease. The total number from this cause is 12, of which one half, i.e. 6 are from Measles, 3 from Whooping-Cough, 1 from Scarlet Fever, 1 from Diarrhoea, and 1 from " other Zymotic disease." In remarking on this record I must here express my great regret that Measles was not one of the Zymotic complaints which it was considered necessary to include in the Notification of Infectious Diseases Act. Unhappily, amongst a large proportion of people Measles is looked upon as a trivial complaint, and no medical treatment is considered necessary. As was admirably stated in the summary for the district of Wandsworth in 1888—This is one of those Zymotic diseases which is thought lightly of by people generally," and, it was added. " This idea is erroneous and fraught with danger." 1 can only express my hearty agreement with these remarks and venture to express a hope that before long we may see Measles included in tlm Act. The time has not yet come 53 when it is possible to estimate the benefits accruing from the enforcement of the Notification of Infectious Diseases Act but there is every reason to hope that before lony, provided that the Act is carried out in and by the mutual and loyal co-operation of the profession and public that we may see the eventual stamping out of many of the more dangerous classes of epidemic disease, and that as vaccination has practically abolished small-pox from our midst, so may the remaining members of the Zymotic group be confined to the narrowest limits. The Zymotic death-rate amounted to 2'4. Sickness &c. among the Union Poor. Amongst the Zymotic class of diseases, 14 cases occurred of Measles amongst the sick poor, 6 of Whooping-Cough, 5 of Diarrhoea, 1 of Erysipelas. Amongst the non-zymotic class the total number coming under treatment amounted to 78 during the year. The number of vaccinations performed was 120 of which all were successful and 3 were postponed. Sanitary Proceedings. All orders for the abatement of nuisances have been complied with, without recourse to legal proceedings. Disinfections, fumigations &c., have been effectually carried out, and no case of recurrence of disease has taken place where this has been done. The usual inspection of slaughter-houses and dairies has taken place, and no reason found found for opposing a renewal of their licenses. I have much pleasure in testifying to the able manner in which Mr. Friedlander, the Inspector of Nuisances, has assisted me and carried out the necessary sanitary work under my instructions. C. de LISLE BROCK, Medical Officer of Health for Tooti>tj/ 54 WANDSWORTH. An exceptionally high rate of health prevailed in this sub-district during the year 1889. The death-rate was the lowest that has been recorded during the existence of the Board of Works. With two or three slight and unimportant exceptions this diminution of mortality occurred amongst all classes of disease, but most notably in the zymotic class, the fatality from which did not reach one half of the average amount; altogether the reduction in the number of deaths is equivalent to a saving of no less than 180 lives, for had the same rate of mortality that prevailed on an average during the preceding ten years continued in the past year, there would have resulted 64 more deaths from zymotic diseases, and 116 more from other diseases than actually took place. The following statistics, derived from the Registrar-General's Returns and the parochial records of sickness and mortality, will be found to furnish satisfactory evidence of the above highly gratifying state of the public health. Vital Statistics. Population. Determined by the official method of the Registrar-General, which assumes a continuance of the same rate of increase of the population since the date of 55 the last census as that which prevailed during the preceding ten years, the mean number of inhabitants of this sub-district, during the past year, amounted to 34,788. Births, Birth-rate, and Rate of Natural Increase. The total nun-iber of births registered during the year was 1,415, = 686 of males, and 729 of females. Allowing for increase of population the births of last year exceeded by 18o the average number of the preceding ten years. Calculated from the official estimate of the population the birth-rate was J220 per 1000, and the rate of natural increase, or the excess of births over deaths, was 24.51 per 1000 persons living of all ages. i Moitaiity The total number of deaths registered during the year, was 494; 242 of males, 252 of females. The number is 217 less than that recorded in 1888, and 180 less than the preceding decennial average. Of the total deaths 108 took place in the following public institutions, vizin the Middlesex (formerly Surrey) County Lunatic Asylum 84; in the Hospital for Incurables7; in St. Peter's Hospital 2; in the Workhouse 5; in the Prison 9; and 1 in the Reformatory for Boys. Causes of Death. All the causes of death are enumerated in the following table; they are classified in accordance with the sysiem adopted by the RegistrarGeneral, shewing the age at death at eight periods, with the number, sex, and social position of the deceased. The deaths from the several diseases of the Zymotic class are separately shewn. TABLE I. STATISTICS OF MORTALITY. WANDSWORTH. Total Deaths from each class of Disease. &e., in the Sub-District. Sex. Age. Social Position. Population (Census) 1881 28,004. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. From 10 to 20 years. At 2ft 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 Classes. Official Population in middle of 1889 34,788. CAUSES OF DEATH. I. Zymotic. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 7 3 4 2 4 .. 1 .. .. .. •• 1 .. 2 4 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. • • .. .. Typhus Fever 1 .. 1 .. .. 1 .. .. .. .. .. .. .. 1 • • Enteric Fever 3 1 2 .. .. .. 2 1 .. .. .. .. .. .. 3 Puerperal Fever 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 Diphtheria 6 3 3 .. 5 .. 1 .. .. .. .. .. .. 1 5 Whooping Cough 6 2 4 3 3 .. .. .. .. .. .. .. 3 1 2 Erysipelas 2 1 1 .. .. .. .. .. 2 .. .. .. .. 1 1 Diarrhoea, Dysentery, and Cholera 21 7 14 20 .. .. .. .. .. 1 .. .. • • 6 15 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 47 17 30 25 12 1 4 2 2 1 .. 1 3 12 313 II. Constitutional. Gout, and Rheumatism 4 2 2 .. .. 2 1 .. .. .. .. 1 1 2 Cancer & other Tumours 21 6 15 .. .. 1 .. 2 9 1 2 •• 3 5 11 Other Constitutional Diseases 7 4 3 5 1 .. .. .. .. 7 .. 2 .. 3 4 Tubercular Phthisis 47 25 22 3 3 1 4 17 17 1 .. .. 4 8 35 19 9 10 10 7 .. .. 1 .. 2 .. .. 1 2 15 Hydrocephalus 5 4 1 2 3 .. .. .. .. .. .. 1 .. 1 4 Scrofula 1 .. 1 1 .. .. .. .. .. .. .. .. .. 1 .. III. Local Nervous 90 54 36 10 6 2 .. 19 29 .. .. 6 27 55 Circulatory 26 8 18 1 .. .. 3 4 9 21 3 2 1 4 25 Inspiratory 87 41 46 23 17 2 2 4 19 9 .. .. 4 18 62 Digestive 31 12 19 7 1 1 .. 4 5 17 11 3 3 2 4 8 4 1 Urinary 17 8 9 .. .. .. 1 .. 6 10 2 1 3 .. .. Generative 5 .. 5 .. .. .. .. 4 1 .. .. .. 2 .. Locomotory 2 2 .. 1 .. .. .. 1 .. .. .. .. .. .. Integumentary .. .. .. .. .. .. .. * * .. .. • • •• 4 .. IV. Developmental. Premature Birth, and Low Vitality, 27 17 10 27 .. .. .. .. .. .. .. .. 4 .. .. Congenital Defects.. 9 7 2 9 .. .. .. .. .. .. .. .. .. 12 1 Old Age 33 14 19 .. .. .. .. .. .. 19 14 3 2 1 1 V. Violence 15 12 3 3 3 .. 1 5 2 1 .. • • 1 .. 1 VI. Ill defined and Ill-defined.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Not specified Not specified 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. .. Totals 94 242 252 128 53 11 16 63 99 100 24 15 37 113 32 57 In addition to the deaths that occurred within the sub-district and recorded in the foregoing table, 112 were registered as having occurred in hospitals and other institutions situated without the sub-district, viz:— In the Infirmary of the Union 69; in the Asylums Board and other Hospitals 43. These are shewn in the following table:— Deaths in Out-lying Institutions. DISEASE. Sex. Age. Institutions. No. Male. Female. Under 1. 1 to 60. 60 and upwards. Union Infirmary. General and Special Hospitals. Asylum Board Hospitals Small Pox .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. Scarlet Fever 2 .. 2 .. 2 .. .. .. 2 Diphtheria 4 3 1 .. 4 .. .. 3 1 Whooping-Cough 2 2 .. .. 2 .. 1 1 .. Typhus Fever .. .. .. .. .. .. .. .. .. Enteric Fever 1 .. 1 .. 1 .. .. .. 1 Diarrhœa 4 .. 4 4 .. .. 1 3 .. Other Zymotic Diseases. 1 1 .. .. .. l 1 .. .. Total Zymotic Diseases 14 6 8 4 9 3 7 4 Tubercular Diseases 25 21 4 1 24 .. 17 7 1 Cancer 9 6 3 .. 5 4 5 4 .. Rheumatism 1 1 . . .. 1 .. 1 .. .. Respiratory Diseases 14 10 4 2 10 2 9 4 1 Circulatory Diseases 7 2 5 .. 4 3 4 3 .. Nervous Diseases 19 7 12 .. 10 9 11 5 3 Other Diseases 11 7 4 2 7 2 8 9 1 Violence 3 2 1 .. 1 2 9 1 .. Age 9 4 5 .. .. 9 9 .. .. Total 112 66 46 9 71 32 69 33 10 58 Death-rate. Determined firm the (fficial estimate of ihe population and the total deaths registered the death-rate of the past year, after correction for deaths in public institutions, was 11.81 per 1000. The correction referred to consists in eliminating from the calculation the number of inmates with the deaths occurring in those institutions situated within the sub-district by which the deathregister is unduly raised; thus, the inmates of the Middlesex County Lunatic Asylum, St. Peter's Hospital, and the Hospital for Incurables, are almost exclusively derived from without the sub-district, undergo no natural increase, and are subject to a high mortality, the latter forming on an average about one fifth of all deaths registered. Such an amount must obviously vitiate any calculation of the death-rate derived solely from the death register, and cause it to represent the fluctuations of the mortality of those institutions, instead of that proper to the sub-district. It might be assumed that the unprecedentedly low death-rate of the past year was due to the circumstance that a larger number of eases of infectious disease were treated in hospital than formerly, but if the whole of the deaths of Wandsworth parishioners that took place in hospitals and other outlying institutions, (and which may fairly be assumed to be equalled by the deaths of non-parishoners within the sub-district) be included in the calculation, the rate would still amount to 14.76 per 1000 only, or 2.24 per 1000 less than that of the healthiest rural districts. The Birth and Death rates for the past and ten preceding years, calculated hy the official method, are compared in the following table;— 59 TABLE III. Birth and Death Rates. Years. Births. Birth-rate. •Deaths from all causes. Death.rate. Rate of Natural Increase. Corrected. Uncorrected. 1879 744 37.97 516 18.04 20.56 19.93 1880 810 30.53 484 15.45 17.67 15.08 1881 901 33.70 507 17.43 17.97 16.61 1882 972 35.28 544 17.49 18.70 17.79 1883 907 32.07 499 16.17 16.71 15.90 1884 1,072 36.72 576 17.23 18.77 18.84 1885 1,122 37.37 628 18.82 19.93 18.55 1886 1,255 40.40 722 19.05 22.33 21.35 1887 1,338 41.96 610 15.58 18.40 24.59 1888 1,451 44.36 711 18.07 20.90 21.78 1889 1,415 42.20 494 11.18 . 14.79 24.51 •Deaths in Outlying Institutions not included. Causation of Mortality. On reference to Table I. it will be seen that the relative proportions borne by the several groups into which the diseases are classified, were numerically as follows:—The Zymotic caused 47, and the Non.Zymotic .431 deaths; the latter including Constitutional 104; Local 258; and Developmental 69. 15 deaths resulted from Violence and in one instance the cause was not specified. Zymotic Diseases. The total number of deaths referred to this group of diseases, all of which with three exceptions belonged to the Epidemic class, was 47, being 80 less than in 1888 and, allowing for increase of population, 04 less than the average of the preceding ten years. They formed 9.5 per cent. of the total mortality, and 1.35 per 1000 of the estimated population; in the previous year they formed 17.5 per cent. of all deaths, and 3.74 per 1000 of the 60 population. That this great reduction in the Zymotic mortality (luring the past year was not due to the removal of a larger number of patients to hospital, the deaths amongst whom are not recorded in this sub-district, is shewn by the circumstance, that by the addition of such deaths to the foregoing calculation, the Zymotic deathrate is still only 1.52 per 1000 of the population. The fatality from each disease of the Epidemic class may with advantage be examined separately. Measles. The very extensive and fatal Epidemic of this disease, which prevailed during the latter six months of 1888, continued in a gradually diminishing extent, to the middle of the past year when it subsided. 7 deaths resulted which were 10 below the average number. Scarlet Fever. This disease was unattended by fatality within the sub-district; but 2 deaths occurred in Hospital and were 7 below the average. Diphtheria. Six deaths occurred from this dissase within the sub-district, and 4 in Hospital; the combined number exceeds the average by 4. Fever, Enteric Five deaths took place in the sub-district and Typhus. and 1 in Hospital, and were 1 less than the average. Whooping- From this disease 6 deaths occurred in the sub-district and 2 in Hospital, and together were 17 less than the average. Diarrhoea. This disease was as usual the most fatal of the class, causing 21 deaths, all of which with one exception occurred to infants under one year of age. The number however is 6 less than the average. Thus the deaths from each disease of the epidemic class were, with the exception of Diphtheria, all below the average, and for the most part very considerably so. 61 Small Pox. There was an entire absence of this disease. Vaccination. According tu the official return of public Vaccination made to the Local Government Board it appears that, of the 1,452 children, whose births were registered in the sub-district during the year 1888, 1,206 were successfully vaccinated; 117 died unvaccinated; in 23 the operation was postponed on account of sickness; 5 were certified as insusceptible; and 3 removed to places, the Vaccination Officer of which was duly notified; the remaining 98 or 6.7 per cent had removed to places which could not be reached or were unknown. The months in which the deaths from epidemic diseases occurred, with the mean temperature of each quarter, are shewn in the following table. The deaths in the third quarter are seen to have far exceeded those of the other quarters, and most of the excess to have been due to Infantile Diarrhoea; of the 44 deaths recorded, 20 occurred in the third quarter, 10 in the fourth, 7 in the first and the same number in the second ouartcr. TABLE IV. DISEASE. January February March April May J une July August September October November December Mean Temp. 38.2 Mean Temp. 54 .5 Mean Temp. 58.9 Mean Temp. 43.5 Small Pox .. .. .. .. .. .. .. .. .. .. .. .. Measles 3 i .. 2 1 .. .. .. .. .. .. .. Searlatina .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria .. .. .. .. .. .. .. 1 1 1 2 1 Whooping Cough 1 1 .. 1 1 .. 1 .. .. .. 1 .. Diarrhuea .. .. .. 1 1 .. 10 7 .. 1 1 .. Fever .. i .. .. .. .. .. .. .. 1 2 • • Totals 4 3 .. 4 3 .. 11 8 1 3 0 1 7 7 20 10 62 The deaths that resulted from the seven principal epidemic and other diseases of the Zymotic class during the past and ten preceding years, with the relative proportion which they bore to the deaths from all causes, are shewn in the following table; the increase and decrease of deaths in 1889 are also compared with the annual average number in the ten years 1879-88, raised in proportion to increase of population:— TAB LIS 1 . COMPARATIVE TABLE OF ZYMOTIC MORTALITY. Diseases. 1879 1880 1881 1882 1883 1884 1885 1886 1887 1888 1 89 1889. No. above corrected average. No. below corrected average Seven principal Epidemic Diseases. Small Pox 1 .. 9 .. .. 1 3 .. .. .. .. .. 1.6 M easles 16 9 5 18 14 6 19 28 20 39 7 .. 13 Scarlet Fever 15 24 19 9 5 5 3 6 1 4 • • .. 10 Diphtheria 1 4 4 3 11 4 6 10 2 6 6 i • • Fever Typhus Enteric 8 6 1 9 12 4 4 8 6 5 4 • • 3.7 Whooping Cough 44 15 12 26 5 17 24 31 8 40 6 • • 19 Diarrhœa Cholera 7 20 19 29 10 27 35 28 30 32 21 • • 6 Total Deaths from above Epidemic Diseases 92 78 69 94 57 64 94 111 67 125 44 .. 55 Other Zymotic Diseases 12 14 7 14 20 19 3 5 4 2 3 .. 8 Total Deaths from Zymotic Diseases 104 92 76 108 77 83 97 116 71 127 47 .. 64 Zymotic Deathrate per 1,000 population 4 14 3.35 2-71 3.72 2.57 2.70 3.07 3.58 2.14 3.73 1.35 .. 2.39 Total Deaths from all causes 516 484 507 544 499 576 628 722 610 711 494 .. 180 Per ceiitage of Deaths from Epidemics to Deaths from all causes 17.8 16.1 13.6 17.2 11.4 11.1 14.9 15.3 10.9 17.5 8.90 .. 8.09 63 Non-ZymoTIc Disease. Local. This group of diseases which always constitutes the great bulk of the causes of death formed over 52 per cent of the mortality of the year. They numbered 258, but were 89 less than in the year preceding. The most numerous of the group were, as usual, diseases of the Brain and Nervous system, the deaths from which were 90 in number, but .30 less than in the previous year, and 49 less than the decennial average The diminution was chiefly due to a decrease in the number of deaths in the Middlesex County Lunatic Asylum; the proportion due to the sub-district proper however does not admit of being accurately ascertained. The deaths from diseases of the Organs of respiration were almost as numerous as the preceding. They were 87 in number, were 41 less than in the previous year, and 29 less than the average; of the total, Bronchitis and Pneumonia contributed 51 and 23 respectively. Diseases of the Digestive Organs caused 31 deaths which are 4 below the average number. Diseases of the Heart and Circulation resulted in 26 deaths, or 19 less than in the previous year, and 10 less than the average. Diseases of the Urinary Organs caused 17 deaths, the average number. The variation in the fatality from the other diseases of the group is almost inappreciable. 84 Constitutional The total deaths referred to this groub Diseases. of diseases were 104 in number, and 15 less than the average. The most fatal were diseases of the Tubercular class causing 72 deaths, to which Consumption alone, which Avas as usual the most fatal single disease, contributed47, thus equalling the total deathsfrom Zymotic diseases. Gout, Rheumatism, Cancer, Tumours, and other constitutional diseases caused 32 deaths, 21 of which were due to Cancer. l>evcioi>mcntai The deaths embraced by this group numbered 69, and were 4 less than the average. To old age unassociated with disease, 33 deaths were referred and to premature-birth, low vitality, and congenital defects, 36. Violence. The deaths from Violence numbered 15, and were 6 less than the average. Ill-defined and In one instance only, that of an infant not specified. found dead, was the cause of death not specified. The following table shews the annual^ number of deaths in the eleven years 1879-89, with the increase and decrease of deaths in 1889 compared with the annual average deaths in 1879-88, raised in proportion to increase of population:— 6o Causes of Death. 1879 1880 1881 1882 1883 1884 1885 1886 1887 1888 1889 1889. TABLE VI.: COMPARATIVE TABLE OF NON-ZYMOTIC MORTALITY. No. above> corrected average. No. below corrected average. Constitutional. Tubercular 62 60 51 69 64 85 90 87 111 114 72 .. 20 Other Constitutional 12 17 19 19 20 18 28 30 32 30 32 5 .. Nervous 96 106 121 106 116 128 145 151 115 112 90 .. 49 Circulatory 20 23 28 28 25 22 36 46 32 43 26 .. 10 Local. Respiratory 125 89 90 87 69 70 101 135 110 128 87 .. 29 Digestive 21 21 28 28 35 47 22 30 30 34 31 .. 4 Urinary 10 11 4 20 13 15 12 26 17 22 17 .. .. Generative 10 1 .. 4 .. 3 6 4 2 5 5 1 .. Locomotory .. 3 2 1 2 2 1 .. 2 6 .. Integumentary .. .. .. 1 •• •• 3 • • • • 1 •• .. 5 Developmental. Premature Birth Malformation 18 27 37 27 23 40 37 45 32 38 41 36 .. 2 Low Vitality Age 26 23 27 27 33 42 34 36 25 33 .. 2 Violence 11 11 20 18 32 21 15 17 13 23 15 .. 6 Ill-defined or Not specified 1 .. 4 1 .. .. .. 3 2 4 1 .. 7 Deaths in relation to Social position. i In the following table is shewn the proportion per cent of the total deaths as well as of the deaths from zymotic disease in relation to tlie social position 01 tiie deceased.. 66 TABLE VII SPOciaL. Position. Total Deaths. Deaths from Zymotic Diseases. 1889. Decennial average. 1889. Decennial Average. Noliility aiul Gentry 3.03 3.31 2.13 1.05 Professional Class, Merchants, Hankers, &e. 7.50 4.64 0.38 4.12 Middle & Trading Classes, Clerks, &c 22.87 23.65 25.53 18.43 Industrial and Labouring Classes 66.60 68.10 65.96 76.10 100 .00 100.00 100.00 100.00 The figures in the table shew inat there was a slight decrease of the general mortality amongst the nobility and gentry, more in the trading class and more still amongst the labouring clasres, while there was, as in the year previous, an increase in the professional class. As regards the zymotic mortality there was, with the except ion of the labouring class in which there was a great reduction, a verj7 considerable proportional increase in all the classes, especially in the trading class in which it exceeded 7 percent. Indeed that which must attract most attention in the table is the very remarkable diminution in the mortality that occurred both from general as well as zymotic diseases, but especially the latter, amongst the labouring classes during the past year. The decrease in the number of deaths amongst them from general disease was l-80 per cent, and from zymotic disease no less than 1014 per cent, below the decennial average. As may be seen on reference to my former reports, the relative decrease of mortality amongst the industrial and working classes has been gradually progressing for many years, and it is submitted 67 that nothing could more satisfactory or markedly indicate the success of the sanitary procedure carried out by the Board. Infantile Calculated from the number of deaths of Mortality. infants under one year of age and th number of births that occurred during the year the infantile death-rate was 9.1 per cent, or 4.4 per cent below the preceding decennial average. This low rate of mortality of infants during the past year was, as might be expected, due to the great reduction in the prevalence and fatality of the diseases peculiarly obnoxious to infant life,—the epidemic. The proportion of the total mortality borne by infants under 1 year of age was 25.9 per cent, the average being 28.6 per cent; of children under 5 years of age, 36.6 per cent; the average being 39.5; of children under 10 years of age 38.8 per cent; All deaths under 20 formed 42.1 per cent, the average being 45.4 Mortality The deaths that occurred at 70 years of age and upwards, formed over 15 per cent, of all deaths. They numbered 70 and were 0 above the corrected decennial average. The females as usual exceeded the males in number and reached the highest ages, as seen in the following table which shews the sex and age of the deceased with the numbers at different periods:— 68 TABLE VIII Age. Males. Females. Total. At 70 and under 75 12 13 25 75 „ „ 80 16 11 27 80 „ „ 85 5 8 13 85 „ „ 90 3 5 8 90 „ 94 .. 3 3 36 40 76 The mean annual number of deaths at high ages relative to population is greater in this sub-district thai in the entire Metropolis, and tnusfar furnishes a favour able indication of the healthiness of the suburb. Sickness and Mortality of the Parochial Poor. The nature and amount of disease with the mortality that resulted amongst the Parochial Poor during the year are shewn in table X. page 17. The total number of fresh cases that came under treatment was 722 and the total number of deaths 27, or 3 per cent. The average number of cases in the preceding ten years was 688, with 32 deaths, or 4.6 per cent. The number of cases of epidemic disease was 58 with one death, the decennial average being 85 cases with 6 deaths. The nature and number of the epidemic diseases that prevailed were Measles 6, Scarlatina 3, Whooping Cough 1, Diarrhœa 36, Fever 6, and Erysipelas 6. They were all unattended by fatality, except Diarrhoea from which one death resulted. Of the Non-Zymotic diseases those of the Respiratory Organs were the most numerous forming over 24 per cent, of all deaths; in the ) ear previous they formed over 30 per cent. 09 The figures contained in the table which represent an accurately ascertained portion of the total sickness and mortality, furnish a reliable indication of the amount and intensity of disease that has prevailed generally throughout the sub-district, and serve to corroborate the information derivable from the statistics contained in the tables of General and Zymotic mortality. Inquests, Deaths from Violence, Uncertified Deaths. The details of the inquests with the verdicts lereon are shewn in the following table:— TABLE IX. Males. Females. Total Deaths from natural causes 15 4 19 „ „ violence, viz:— Run over by Train 1 Scalds 1 — Drowning 2 — . Suffocation in bed with Parents • • 3 Accidental Fracture of skull, run over by Van 1 - 11 Fracture of ribs by a fall 1 - Concussion of brain by a fall on the head 1 - Suffocation by fire and smoke 1 - Suicidal Pistol shot 1 1 Homicidal Manslaughter by a blow 3 — 2 Execution 1 - Primary came undetermined. . / Fracture of ribs, how ) caused not known 1 - 2 ( Found Dead 1 27 8 35 From the foregoing table it is seen that the number of Inquests held during the year was 35, being 7 less than in the year previous, and related to the cause of 70 death of 27 males and 8 females. The deaths were thus referred:—To natural causes 19; to Violence 15; of the latter 11 were Accidental, 2 Homicidal and 1 Suicidal, one was not ascertained, and in one instance a verdict of "found dead" was returned. There were two cases only in which the cause of death was not ascertained by medical testimony and these were investigated by the Coroner who considered further inquiry unnecessary. Sanitation. The nature and amount of the Sanitary operations of the past year are, as far as practicable, set forth in Table XI. page l9. The numbers relating to Water-supply, Water-closets, New Drains, Dustbins, and other details arising out of the building of new houses, and, with few exceptions, all the figures relating to the structural and other defects of houses as well as those referring to the general removal of nuisances will be found to have been very considerably in excess of those of the year preceding. Those representing the results of house to house inspection were fewer; 4395 houses and premises were so examined and their conditions recox-ded in the House-Inspection Register; the number is less by 127 than in the previous year, but this does not furnish an indication of a decadence from the activity of former years but, fortunately, of a lessened necessity for the domiciliary visits of the Inspectors. This is readily understood when it is remembered that an excessive amount of epidemic disease was present in 1888, whereas in the past year there was a remarkable immunity from such disease, the fatality from which as has been already shewn, was less than half the average amount. Hence also the number of houses that were disinfected were not so numerous by 114, although that process was carried out in all instances in which any one of the seven principal epidemic diseases had been present. 174 houses were so dealt with, Sulphur Vl igation for the most part being, as Usual, the agent employed. In seven instances, the process had to be repeated in consequence of the occurrence of further cases of infectious disease, but in three instances only was there a recurrence of disease beyond the period of incubation during which it was possible for the patient to have become infected before the first disinfection of the rooms. The number is very small considering how many patients are retained at their homes. It may be here remarked that there is still considerable difficulty experienced in inducing parents to avail themselves of the great advantages, both to the patient end the rest of the family, of prompt separation of the infected sick from the healthy by removal to Hospital—which is at once the most simple and efficient means for the prevention of the spread of infectious disease and consequently of much suffering and loss of life; and it is much to be regretted that the Board has not the power to effect the compulsory removal of infected patients to Hospital where the means of isolation at their own homes are unattainable. 749 complaints were submitted to the Local Committee and duly attended to. All the Cow-houses 17 in number, and the Slaughterhouses 8 in number, were as usual examined and reported on as to their condition, and that they were furnished with all the Sanitary requirements necessary to admit of a renewal of their owners' licenses. The Bake-houses also, numbering 37, were inspected twice in the year and found in a satisfactory condition. With the exception of two instances in which it became necessary to obtain the assistance of the Police Magistrate the whole of the Sanitary procedure was conducted without the necessity of an appeal to the law, and was carried out in a manner commensurate with the merits of the sub-district; and I have much pleasure in testifying to tlie satisfactory manner in which the Sanitary Inspectors have fulfilled their respective duties. The remarkably low death-rate, high birth-rate and low rate of infant mortality, with the other statistics exponent of the public health recorded in the foregoing pages, furnish most conclusive and reliable evidence of the unprecedentedly high status of the health of the sub district during the year 1889. GEORGE EDWARD NICHOLAS, M.D., Medical Officer o) Health for Wandsworth May, 20tli 1890. BEPORT of the public analyst on the work done under the sale of food and DRUGS ACT DURING THE YEAR 1889. To the Wandsworth District Board ok Works. Gentlemen, In accordance with the annual custom, I beg to furnish you with a report upon the work done under the provisions of the sale of Food and Drugs Act during the year 1889. The total number of samples submitted by the Inspector was 19X, out of which 26 were condemned as adulterated, thus showing that 13 per cent of the whole of the articles examined were found to be bad. The samples brought in were sufficiently varied, and the selection made showed that Inspector Smith had applied his long experience of the work under the Act to the best advantage and that he had performed his duties in a perfectly satisfactory manner. The only articles that were found to have been subjected to sophistication were milk, butter, coffee, and olive oil, and the results may be shortly summarised as follows:— Nature ot Article. Samples submitted. Samples adulterated Per centage. Milk 75 12 16.00 Butter 26 5 19.23 Coffee 27 3 11.11 Pepper 20 3 16.00 Olive Oil 3 3 100.00 Various other articles found to be pure 47 0 Total 198 26 General average 13 Although the amount (if adulteration is thus shown to be considerable in certain special articles, yet as a wliole the general state of the food supply of your district will compare favourably with that of any other part of London in which the Working of the Act is equally strictly earned out. I have the honor to be, Gentlemen, Your obedient servant, JOHN MUTER, Ph.D.; F.R.S. (Edin.); F.I.C., Public Analyst. South London Central Public Laboratory, Kenning ton Hi, ad, S.E