CAR 032 ANNUAL REPORT ON THE Urban district (or parish) OF CARSHALTON, SURREY, For the Year 1897, By E. L. JACOB, Medical Officer of Health. CONTENTS. I. Statistics: Births and Deaths. II. Summary of Sickness and Mortality from the Seven Principal Zymotic Diseases, and from certain Other Infectious Diseases, and of the Action taken for Preventing their spread. III. Summary of other Sanitary Proceedings which were taken during the year. 1Y. Appendix, containing certain Tables. Prepared in accordance with Sec. 14 of the Order of the Local Government Board, dated 23rd March, 1891, regulative/ the duties of Medical Officers of Health. William Pile, Printer, "Herald" Works, Carshalton. CARSHALTON URBAN DISTRICT. Area, 2,926 Acres. Population at Census in 1871, 3,668; in 1881, 4,841; in 1891, 5425. Number of inhabited Houses at Census in 1871, 732; in 1881, 910; in 1891, 1091. MEDICAL OFFICER'S REPORT FOR THE YEAR 1897. I.-Vital Statistice: Births and Deaths. 1. The population of the Parish in the middle of the yrar may be estimated at 5,750 persons. 2. The number of Births registered in the Parish during the year was 161, or thirteen less than in the previous year. The Birth-rate for the year, therefore, was 28 per 1,000 of the estimated population. 3. The number of Deaths registered in the Parish during the year was 76 (as against 67 in the preceding year), to which must be added eleven deaths in the Epsom Workhouse and County Asylum of persons belonging to the Parish. These 87 deaths represent an Annual Death-rate of 15.1 per 1,000 of the population, estimated as above. In the other portions of the Surrey Combined Sanitary District the highest Birth-rate for the year was 26.4, and the lowest was 17.4; while the highest Death-rate was 13.9, and the lowest was 8.2. 4. As to the Infont Mortality. The Deaths of Infants under one year were 29 in number, as against 20 in the preceding year, and were equal to 18 per cent. of the registered births, which is much above their previous average rate in the Parish. This high infant mortality was chiefly due to the unusually large number of deaths from diarrhœ. 5. The deaths from pulmonary Consumption (seven in number) were at the rate of 1.2 per 1,000 of the estimated population, and were about the previous average rate in the Parish. 6. The deaths from other lung diseases (Bronchitis, Pleurisy, and Pueumonia) were 16 in number, as against seven in the preceding year, and were at the rate of 2-8 per 1,000 of the estimated population, which is above their previous average rate in the Parish. (See also Tables 1., II,. and V. at the end of the Report.) II.-Summary of Sickness and Mortality from the Seven Principal Zymotic Diseases, and form the other Diseases which must be notified under the Infectious Diseases (Notification) Act, 1889, and of the action taken for preventing their spread. 1. No Case of Small Pox was reported during the year. 2. Measles caused no death. 3. Whooping Cough caused no death. 4. Scarlet Fever (otherwise called Scarlatina) was unusually prevalent in the district during the last three months of the year, as will be seen on reference to Table III. at the end of the report. Altogether, 28 cases were notified in 20 houses, nine of which were in and near Mill Lane. At the end of November, attendance at the Infant School in Mill Lane was contributing very largely to the spread of the disease, and the School was accordingly closed, by my advice, from December 3rd to the end of the year. Four of the sick were admitted for treatment into the Sutton Urban District Council's hospital at Sutton, whence one of them was afterwards removed to the new Joint Hospital on Cuddington Downs ; five were admitted into the Epsom Rural District Council's temporary hospital on Clieam Common, and were afterwards transferred to the Joint Hospital, and eighteen were removed direct to the Joint Hospital, where two of them died. (4) 5. Of Diphtheria two eases were notified, viz., one in March at Carshalton-on-the-Hill, and one in August at a house in the Carshalton Road. In the latter case the patient was attacked with "sorethroat " while on a visit in another part of the County, and, on his return home, the nature of the illness could only be diagnosed after a bacteriological examination. 6. Of Enteric (otherwise called Typhoid) Fever there were four cases, the chief features of which are shown in the following Table: Situation of Premises. Persons attacked. Dates of attacks. Remarks. At the back of the Church. A woman. October. One of the children had just previously returned from Guy's Hospital, where the illness for which he had been admitted there was said to have been typhoid fever. Offensive cesspit privy on premises. Water got from watercourse at back. Patient was removed to the Joint Hospital. High Street. Child, Aged 4. November. Patient was removed to the Joint Hospital. Foul cesspit privy on premises. Sink drainage defective. Wandle Mount. Boy, Aged 12. December. Patient was admitted into the Croydon General Hospital for "tubercular meningitis," but the disease proved to be enteric fever, and he was then removed to the Croydon Borough Isolation Hospital. Offensive hand-flushed W.C. House drain defective and not ventilated. West Street. Youth, Aged 20. December. Patient was removed to the Joint Hospital and died there after the end of the year. Illness might have been contracted in London, where he worked daily. 7. Diarrhcea, which was very fatally prevalent among infants last summer in some other parts of the county, caused 15 deaths, 14 of which were among childreu under five years of age. The total deaths from the "Seven Principal Zymotic Diseases" were 17 in number—viz., two from Scarlet Fever and 15 from Diarrhoea—and were at the rate of 2.9 per 1,000 of the population. In other portions of the Surrey Combined Sanitary District the highest Zymotic Death-rate was 2.5, and the lowest was nil. (See also Tables III., IV., and VI. at the end of the Report.) As regards the other infectious diseases which have to be notified under the above-mentioned Act: No case of Membranous Croup or "Continued Fever" was notified. Of Puerperal Fever one case, which ended fatally, was notified in April. Of Erysipelas there were two cases, one in July and one in October. The following is a summary of the further action which was taken for preventing the spread of some of these diseases:—The houses infected with Enteric Fever, Scarlet Fever, or Diphtheria were visited by the Inspector and myself; isolation of the sick was inculcated, and was assisted by the removal of 31 to an isolation hospital; disinfectants for use during illness were supplied and their proper use explained; all nuisances and sanitary defects discovered upon the premises were remedied as far as was practicable; and, after the death, removal, or recovery of the sick, formal notices to cleanse and disinfect the infected rooms and their contents were, in 21 instances, served on the owners or occupiers. From the houses of the poor the infected bedding was removed and was disinfected by Mr. R. F. Hollo way, of Hackbridge, at the expense of the District Council. The Joint Isolation Hospital on Cuddington Downs, for the use of persons residing in this district, and in the Epsom Rural, the Sutton Urban, and the Leatherhead Urban, Districts, was opened for the reception of patients on October 28, and the number of those who were removed into it from this District has already been stated. Ill—Summary of other Sanitary Proceedings, &c., which were taken during the year. 1. The Council this year contracted for the weekly removal of house refuse from premises in their district, instead of for its fortnightly removal as in previous years, with the result that few complaints were made of its non-removal. (5) 2. The slaughterhouses (three in number), the bakehouses (seven in number), and the premises of the registered cow-keepers, dairymen, and purveyors of milk (six in number), were inspected. 3. As to the Bye-Laws relating to new streets and buildings : The Surveyor has been good enough to inform me that— In 1884 In 1885 In 1886 In 1887 In 1888 In 1889 In 1890 In 1891 In 1892 In 1893 In 1894 In 1895 In 1896 In 1897 The number of new buildings, and of additions to buildings, of which plans were submitted for approval under the ByeLaws, was 41 9 12 13 9 6 10 12 13 24 54 62 48 39 The number of new streets, ditto, was 3 none none 4 4 4 4 none 4 none 4 none none 3 The number of times that legal proceedings were taken for breach of the Bye - Laws relating to streets & buildings was none none none none none none none none 2 none 3 none none none 4. Proceedings under Sees. 150 and 152 of the Public Health Act, 1875, and uuder the Private Street Works Act, 1892. The Surveyor informs me that the number of streets (not being highways repairable by the inhabitants at large), which were sewered, levelled, paved, metalled, flagged, channelled, or lighted during the year, after notice to their respective frontagers, under these Acts, with a view to their being declared to be highways, was one, as against three in 1884, two in 1886, two in 1887, four in 1888, two in 1889, four in 1890, two in 1891, three in 1892, one in 1893, none in 1894, none in 1895, and four in 1896. 5. Proposed Cemetery. In April, at the request of Dr. Hoffman, my Deputy (Dr. Williamson) inspected the land which the District Council proposed to acquire for the purpose of a cemetery, with the object of determining whether any water-supplies in the neighbourhood would be likely to be contaminated if interments took place there, and he reported that he saw no reason to think that they would. The Council have since acquired the land. 6. As to Works of Sewerage and of Sewage Disposal. Satisfactory progress was made with the task of laying sewers in all the populous parts of the district, and with the buildings, tanks, and other works for the disposal of the sewage at the outfall. The Surveyor informs me (a) that the Council have decided to lay a sewer for the use of about a dozen dwelling houses and three mills in an isolated portion of their district, near Beddington Corner, and have agreed with the Croydon Rural District Council as to the terms on which the latter will admit the sewage and trade refuse into their sewers, which are close at hand, and (6) that they have agreed with the Sutton District Council as to the terms on which they will admit the sewage from a house in Albion Road (one frontage of which is in the Sutton District) into their system of sewers. The Surveyor also informs me that during the year the drains of all the houses in Prince of Wales' Road, of four houses in Duke of Edinburgh Road, and of some in Wrythe Lane, were connected with the new sewers. 7. A systematic insjiection of houses at Carshalton-on-the-Hill, at Wandle Mount, in St. James' Road, and Mill Lane, was made by the Sanitary Inspector, by my Deputy (Dr. Williamson) and myself and defects of the closets, of the drainage, and of the dwellings were remedied as far as was practicable, but there are many defects there and elsewhere, which can only be effectually dealt with when the new sewers are ready for use. The question of providing houses for the Working Classes, under Part III. of the Act of 1890, was considered by the Council, but nothing was decided before the year closed. (6) 8. The following is the Sanitary Inspector's return of the Nuisances dealt with, and other work done during the year:— Number of Complaints received in writing 15 Number of premises inspected under Sec. 92 of the Public Health Act, 1875 696 Number of Nuisances discovered 161 Ditto reported to the Sauitary Authority 161 Ditto remedied after report 161 Number of Notices served for the Abatement of Nuisances, under Section 91 98 Ditto Ditto under Sec. 32 of the Housing of the Working Classes Act, 1890 6 Particulars of Work done by owners or occupiers, for the abatement of Nuisances, in compliance with notices: Number of privies, cesspools, ditches, pools, watercourses, urinals, ashpits, and drains, cleansed, and number of deposits removed 263 Number of old privies re-constructed as water-closets Number of Premises at which the drains were re-constructed, ventilated, trapped, or disconnected from the house pipes or rain-water pipes 70 Number of Premises at which new drains or cesspools were provided under Sec. 23 or Sec. 94 30 Number of Premises from which animals, improperly kept, were removed 2 Number of Houses which were provided with efficient ventilation 5 Number of Houses at which injurious overcrowding was abated 4 Number of damp, unwholesome Houses, which were repaired 54 Number of filthy Houses which were cleansed and whitewashed 46 Legal proceedings taken, under Sec. 96, tor Abatement of Nuisances (number of times) 22 Ditto under Sec. 32 of Housing of Working Classes Act, 1890 (No. of times) 4 Houses condemned by the Justices as unfit for human habitation, under Sec. 97 1 Ditto Ditto under Housing of the Working Classes Act 4 Number of Samples of Water sent to the Medical Officer of Health for Analysis 4 Number of Wells permanently or temporarily closed, after notice, under Sec. 70 of the Public Health Act, 1875, as unfit for drinking or domestic purposes — Number of Houses to which water was supplied by owners of premises after notice, under Sec. 62 of that Act — Among other nuisances which received special attention was that arising from the discharge of sewage from a large number of houses in the Sutton Urban District into a ditch in this district. The Sutton Local Board had long since given notice to the owners to connect the drains of these houses with the new sewers, but the owners had argued that the drains were already connected with sewers vesting in the Local Authority, and that the Board must divert them at their own expense, and so nothing had been done. The Carshalton District Council now served notices on the owners and on the Sutton District Council to stop the nuisance, with the result that the Sutton District Council have decided to do the work, and the owners have agreed to contribute a certain sum towards the cost of it. (7) 8. As to Water Supply. Samples of water, which were sent me from wells and pumps at the undermentioned places, were examined, with the results shown in the following table: When the Samples were taken. Source of Supply Situation of Premises. The Water was found to be Action taken by Owners or Occupiers. July 17th Pump Pound Street Polluted The well was cleaned out and the source of pollution discovered and removed. October 15th Well Near Hackbridge Very impure ,, 25 th Same well Ditto Ditto Water laid on. Public pump Pound Street Of good quality E. L. JACOB. H, Altenburg Gardens, New Wandsworth, S.W. February, 1S98. (The usual Tables are appended to the Report.) (8) APPENDIX. TABLE I. TABLE OF DEATHS in the District during the year 1897, classified according to Diseases and Ages; and shewing also the Population of the District and the Births therein during the year. Population at all ages. Mortality from all causes at subjoined ages. Mortality from subjoined causes, distinguishing Deaths of Persons under 5 years of age. At Census 1891. Estimated to middle of 1897. Reoistebed Births. All ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Age. Small Pox. Measles. Scarlatina. Diphtheria. Membranous Croup. Whooping Cough. Contiud. Fever. Diarrhoea. Rheumatic Fever. Erysipelas. Puerperal Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Injuries. All other Diseases. Typhus. Enteric or Typhd. Other or doubtful. 5425 5750 161 76 28 7 3 2 21 15 Under 5 14 7 1 1 12 5 and upward 1 6 8 6 1 19 At all ages 14 1 6 15 7 2 31 The subjoined numbers have to be added to the above, in judging of the mortality in this District. Deaths outside the District of persons belonging thereto. 11 1 1 2 1 3 3 Under 5 1 1 5 and upwards 1 1 1 1 1 1 3 TABLE II. Shewing the estimated population, the Annual Birth-rate, and certain Death-rates, for each of the twenty-four years, 1874.97. Years. POPULATION Estimated to middle of each year. Registered Births. Deaths from all Causes. Deaths of Infants under 1 year. Deaths from Pulmonary Consumption. Deaths from other Lung Diseases. Number. Rate per 1000 of the population. Number. Rate per 1000 of the population. Number. Per cent. to Regd. Births. Number. Rate per 1000 of the population. Number Rate per 1000 of the population. 1874 4035 137 33.9 68 16.8 20 14½ 2 0.5 4 1.0 1875 4148 136 32.7 80 19.2 12 18¾ 6 1.4 5 1.2 1876 4261 143 33.5 77 18.0 23 16 7 1.6 13 3.0 1877 4374 145 33.3 63 14.4 11 8 5 1.1 9 2.0 1878 4460 140 30.8 73 16.3 22 15¾ 8 1.8 11 2.5 1879 4510 170 37.4 83 18.4 22 13 7 1.5 22 4.9 1880 4610 149 32.8 74 16.0 26 17¼ 6 1.3 12 2.6 1881 4850 151 31.1 78 16.1 19 12½ 10 2.0 9 1.9 1882 4900 176 36.0 89 18.0 29 16½ 7 1.4 13 2.6 1883 4950 136 27.5 75 15.1 14 10¼ 10 2.2 18 3.6 Average of 10 years 32.7 16.8 13¼ 1.5 2.5 1884 5000 144 28.8 71 14.2 16 13¼ 3 0.6 10 2.3 1885 5050 152 30.2 61 12.0 20 13¼ 5 1.0 12 2.3 1886 5100 145 28.4 71 14.0 15 10¼ 8 1.5 13 2.5 1887 5150 144 28.0 67 12.0 13 9 5 0.9 5 0.9 1888 5200 135 26.0 77 15.0 16 12 6 1.1 12 2.2 1889 5300 180 34.0 65 12.2 21 11¾ 6 1.1 6 1.1 1890 5400 148 27.4 83 15.4 24 16¼ 12 2.2 14 2.6 1891 5450 167 30.6 88 16.1 16 9¼ 8 1.5 8 1.5 1892 5500 158 29.0 84 15.3 19 12 5 0.9 15 2.7 1893 5550 158 28.5 75 13.5 14 9 4 0.7 12 2.2 Average of 10 years. 29.1 14.0 11½ 1.2 2.0 1894 5600 162 29.0 81 14.5 23 14 2 0.4 14 2.5 1895 5650 175 31.0 101 17.9 31 17¾ 10 1.8 18 3.2 1896 5700 174 30.5 76 13.3 20 10½ 8 1.4 7 1.2 1897 5750 161 28.0 87 15.1 29 18 7 1.2 16 2.8 N.B.—The deaths of Parishioners in the Workhouse and other Public Institutions are included in this table. (9) TABLE III. Shewing the Sickness and Mortality recorded in the District from the under.mentioned Zymotic Diseases in each month of the year 1897, and in the seven preceding years. 1897. Scarlet Fever. Diphtheria. Enteric (or Typhoid) Fever. Cases Houses Rem'd to Hospl. Cases Houses Rem'd to Hospl. Cases Houses Rem'd to Hospl. January February March 1 1 April May June 1 1 1 July 1 1 August September 2 1 2 October 6 3 6 1 1 1 November 12 9 11 1 1 1 December 7 6 7 2 2 2 Total in 1897 28 20 27 2 2 4 4 4 Total in 1896 4 3 13 8 2 2 Total in 1895 15 10 8 2 1 1 Total in 1894 6 6 1 1 5 5 Total in 1893 25 10 3 3 Total in 1892 4 4 Total in 1891 5 4 8 0 2 2 Total in 1890 22 8 10 10 4 3 TABLE IV. Shewing the number of Deaths in the District from each of the seven principal Zymotic Diseases during the twenty.four years, 1874—1897, and the Zymotic Death.rate for each of those years. Year. Small Pox. Measles. Scarlatina. Diphtheria. Whooping Cough. Continued Fever. Diarrhœa. TOTAL. Typlius. Enteric or Typhoid Other kinds. Number. Rate per 1000 of the population. 1874 .. 5 .. 1 4 .. .. .. 2 12 3.0 1875 .. .. 18 .. 1 .. 1 .. .. 20 5.3 1876 .. 6 8 .. 2 .. 3 .. 4 23 5.4 1877 .. .. .. .. .. .. .. .. 1 1 0.2 1878 .. .. .. 3 1 .. 2 .. 4 10 2.2 1879 .. .. .. 1 4 .. .. .. .. 5 1.1 1880 .. .. .. 1 9 .. .. .. 2 12 2.6 1881 .. 2 8 .. 2 .. .. .. 3 15 3.1 1882 .. 6 1 .. 1 .. .. .. 2 12 2.4 1883 .. 1 .. .. .. .. 1 .. 2 4 0.8 1884 .. 2 .. 1 3 .. 2 .. 1 9 1.8 1885 .. 2 .. .. .. .. .. .. 2 4 0.8 1886 .. 8 .. .. 6 .. .. .. 1 15 3.0 1887 .. .. .. .. .. .. 1 .. 2 3 0.6 1888 .. 1 .. .. .. .. .. .. 3 4 0.8 1889 .. 2 .. 1 5 .. .. .. .. 8 1.5 1890 .. .. .. 1 2 .. .. .. 2 8 1.5 1891 .. 6 .. 2 .. .. 1 .. 1 10 1.8 1892 .. .. .. .. 1 .. .. .. 1 2 0.4 1893 .. .. .. .. 4 .. .. .. 3 7 1.3 1894 .. 8 .. .. .. .. 1 .. .. 9 1.6 1895 .. 3 .. 1 .. .. 1 .. 5 10 1.8 1896 .. 1 .. 1 .. .. l .. 3 6 1.05 1897 .. .. 2 .. .. .. .. .. 15 17 2.9 (10) TABLE V. Shewing certain DEATH RATES, and the BIRTH RATES, for the Year, 1897, in each Rural and Urban District of the Surrey Combined Sanitary District. SANITARY DISTRICTS. Estimated Population at middle of 1897. Births. Rate per 1,000 of the Population. Annual Rate of Mortality per 1,000 of the Population, from Per centage of Deaths under One Year to Registered Births. Number of Deaths from Small Pox. Measles. Scarlatina. Diphtheria. Membranous Croup. Whooping Cough. Fevers. Diarrhœa. All Causes. The 7 principal Zymotic Diseases. Pulmonary Consumption. Other Lung Diseases. Chertsey Rural 10,900 26.4 10.2 0.9 0.8 2.0 11.5 10 Chertsey Ubban 12,600 25.7 13.9 0.95 2.2 1.5 10.8 1 1 1 9 Weybridge Urban 4,500 18.1 8.2 1.1 0.9 6.8 Walton Urban 8,800 24.4 9.5 0.8 1.1 1.5 9.7 1 6 Dorking Rural 10,770 17.4 11.2 0.3 1.1 1.3 60 2 1 Dorking Urban 7,600 23.5 12.4 1.0 1.3 1.6 7.3 5 1 1 1 Epsom Rural 16,680* 22.6 11.5 0.6 0.8 1.0 10.1 3 1 4 1 2 Epsom Urban 9,000 23.7 11.8 1.2 0.8 1.9 14.5 11 Carshalton Urban 5,750 280 15.1 2.9 1.2 2.8 18.0 2 15 Sutton Urban 13,800* 230 13.2 2.5 1.3 1.9 13.9 3 6 3 23 Leatherhead Urban 4,850 20.8 10.5 1.4 1.0 1.2 8.9 1 1 5 Reigate Rubal 15,100 25.3 10.6 0.2 0.66 1.8 8.0 1 2 Reigate Urban 24,400* 22.5 11.1 1.06 10.2 1.6 9.6 1 1 2 1 2 19 Entire District 144,750 23.35 11.56 10.3 1.1 1.6 10.47 — 2 4 15 1 13 11 104 *Note.—The Population and Deaths at the Banstead Asylum and at the Kensington and Chelsea District Schools, in the Epsom Rural District; at the South Metropolitan District Schools, in the Sutton Urban District; and at the Earlswood Asylum, in the Reigate Urban District, have been excluded from the Table. The Deaths in the Chertsey, Dorking, Epsom, and Reigate Workhouses and Cottage Hospitals of persons belonging to the adjoining Rural Sanitary Districts have been transferred to those Districts. (11) TABLE VI. Shewing the NEW CASES OF INFECTIOUS SICKNESS coming to the knowledge of the Medical Officer of Health during the year 1897 in the undermentioned Sanitary Districts. Sanitary Districts. Aged under 5 or over 5. New Cases of Sickness in each District, coming to the Knowledge of the Medical Officer of Health. Number of such Cases Removed from their Homes in the several Districts for Treatment in Isolation Hospital. Smallpox. Scarlatina Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Enteric Fever. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Chertsey Rural Under 5 1 1 5 upwards 10 1 4 4 10 1 Chertsey Urban Under 5 4 7 1 2 6 5 upwards 13 16 4 3 12 10 13 2 Weybridge Urban Under 5 5 upwards 6 2 1 5 Walton Urban Under 5 2 2 5 upwards 13 4 4 2 5 3 2 Epsom Urban Under 5 12 2 4 5 upwards 30 2 4 1 9 19 2 Sutton Urban Under 5 4 1 3 5 upwards 24 8 11 3 19 1 1 Carshalton Urban Under 5 9 1 1 8 1 5 upwards 19 1 3 1 2 19 3 Epsom Rural Under 5 4 4 1 1 1 2 5 upwards 1 30 9 5 7 1 19 8 Leatherhead Urban Under 5 10 2 9 2 5 upwards 32 4 3 25 2 Dorking Rural Under 5 1 2 1 1 5 upwards 3 7 3 1 5 Dorking Urban Under 5 6 5 upwards 18 2 2 5 Reigate Rural Under 5 17 10 5 upwards 31 5 4 3 11 19 Reigate Urban Under 5 21 17 5 upwards 101 7 7 6 86 1 Totals in 1897 Under 5 85 25 1 1 1 3 57 10 1 5 upwards 1 312 82 56 2 9 67 1 236 29 10 Totals in 1896 Under 5 101 33 5 2 6 62 8 5 upwards 1 313 116 1 34 1 1 90 214 26 1 Totals in 1895 Under 5 50 28 2 1 2 5 31 9 5 upwards 221 112 1 51 2 8 77 122 35 3 Totals in 1894 Under 5 60 27 11 2 1 6 29 7 5 upwards 3 267 100 1 48 2 10 109 1 139 24 4 Totals in 1893 Under 5 107 33 20 5 14 38 3 5 upwards 31 735 145 4 66 2 18 168 12 256 15 1