HAY 007 THE URBAN DISTRICT COUNCIL OF HAYES. Annual Medical Report FOR THE YEAR 1921. BY E. S. PHILIPS, m.R.c.s., ii.RCP. MEDICAL OFFICER OF HEALTH. E. R, Wuscotr and Son, Printers, UxBRiDt. HAYES URBAN DISTRICT COUNCIL. Public Health & Housing Committee, 1921. CHAIRMAN: COUNCILLOR R. W. GUNTON, J.P. members: COUNCILLOR J. W. DAVIES, J.P. (Chairman of the Council). F. H. CONWAY. 1. ELLIS. L. FOWLER. H. S. GREENHEAD. R. J. LEACH. A. E. KNIGHT. W. RAWLINGS. OFFICIAUS : Clerk MR. A. B. BAKER. Assistant Clerk MR. A. E. HIGGINS. Surveyor MR. D. C. FIDLER, M. Inst. M. & Cy. E. Sanitary Inspector MR. J. C. PALMER, A.R.S.I. Collector & Assist. Overseer MR. R. G. HAREWOOD. Medical Officer of Health DR. E. S. PHILLIPS, M.R.C.S. The Annual Report of the Medical Officer of Health for the Year ending December, 1921. To the Hayes Urban District Council. Mr. Chairman and Gentlemen, I beg to submit my Third Annual Report, which is somewhat curtailed compared with that of former years. It is compiled in accordance with the instructions of the Ministry of Health, and contains a record of the work of the Public Health Department. General Statistics. Area (acres) 3311 Population (Census 1911) 4261 „ „ 1921 63O4 „ estimated end of 1921 7000 Number of Houses occupied 1500 Rateable Value £64686 Sum represented by a id. rate £270 Extracts from Vital Statistics. M. F. TOTAL. Births Legitimate 64 68 132 Illegitimate - 4 4 64 72 136 Birth rate per 1000 population ... ... 19,43 M. F. TOTAL. Deaths 26 26 52 Death rate per 1000 population ... .... 7.43 3 BIRTHS. The birth-rate shews a slight decrease compared with that of 1920, though it is higher than those years immediately preceding. Under the "Notification of Births Act," 125 births were notified to me. DEATHS. During 1921 the total number of deaths that were registered was 45, of which 24 were males and 21 females. The gross death-rate is therefore 6.42 per 1000 of the population. 13 deaths of inhabitants have taken place outside the district, and after deducting the transferable deaths (6), the net. number of deaths in Hayes is 52, 26 males, and 26 females. This gives a net death rate of 7.43. 1 am indebted to the Registrar-General for the following table showing the death-rate and birth-rate in England and Wales and in certain parts of the Country in 1921. TABLE XV.—Birth-rate, Death-rate and Analysis of Mortality during the Year 1921. Provisional figures. Populations as enumerated in I92I have been used for the purposes of this Table. The mortality rates , tfer to the whole population as regards England and Wales, but only to civilians as regards Loudon and the groups of towns). Birthrate per 1000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1000 Births Percentage of Total Deaths. All Causes. j Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping-cough. Diphtheria Influenza. Violence. Diarrhoea and Enteritis (under 2 years). Total Deaths under One Year Deaths in Public Institutions. Certified Causes of Death. Inquest Cases. Uncertified Causes of Death. England and Wales 22.4 12.1 0.02 0.00 0.06 0.03 0.12 0.12 0.23 0.44 15.5 83 25.5 92.5 6.4 1.1 96 Great Towns, including London (1911 Census Populations exceeding 50,000) 23.3 12.3 0.01 0.00 0.08 0.04 0.13 0.15 0.23 0.40 19.3 87 33.2 92.5 6.8 0.7 148 Smaller Towns (1911 Census Populations 20,000—50,000) 22.7 11.3 0.01 0.00 0.05 0.03 0.11 0.11 0.26 0.35 15.6 84 17.7 93.5 5.1 1.4 London 22.3 12.4 0.01 - 0.05 0.06 0.12 0.25 0.23 0.42 21.3 80 49.2 91.6 8.2 0.2 According to the above table the birth-rate for all England and Wales was 22"4 and for the Hayes District 19.43, which is slightly below the average. The death-rate for England and Wales was 12.1, whereas Hayes Urban District was 7.43, which is considerably below the general average and very satisfactory. 4 The principal causes of death were:— Phthisis 6 Cancer 5 Cerebral Haemorrhage 5 Heart Disease 5 Enteritis and Diarrhoea 6 Apart from Phthisis and Pneumonia, there were no deaths from infectious diseases. The following list gives the number of deaths occurring at the various periods of life. Infancy (under one year) 7 Youth (up to 25 years) 7 Middle age (25 to 45 years) 6 Later Life (45 to 65 years) 16 Old age (over 65 years) 16 52 INFANTILE MORTALITY. The total number of deaths that occurred among infants under one year of age was 7. Therefore the infantile mortality rate, that is to say, the proportion of deaths under one year of age per 1000 children born is again remarkably low, namely 51'47, a figure which compares very favourably with past years. The rate for all England and Wales for 1921 was 83. The corresponding figures for Hayes for the last four years were :— 1920 47'24 1919 111.1 1918 90.0 1917 707 To the courtesy of Mr. E. J. Burridge, registrar, I am indebted for the following data regarding vaccination and poor law relief. VACCINATION. Number of children Vaccinated 49 Number of exemption certificates granted 60 5 POOR LAW RELIEF The amount of poor law relief distributed, including relief given to the unemployed, for the year ending December 31st, 1921, was £788 13s. 3d. HOSPITALS. The Cottage Hospital in Grange Road has been further extended, an operating theatre having been built and equipped. For infectious cases there is the Joint Isolation Hospital, Kingston Lane, Uxbridge, where ample accommodation exists for the reception of cases of Scarlet Fever and Diphtheria. There is also the Joint Small-Pox Hospital situate at Yeading. The two branches of Maternity and Infant Welfare Centres in the district continue to be well patronised, and are doing excellent work. At the end of the year 1921, the Council decided to appoint a Lady Health Visitor. At the time of going to print, she has commenced her duties and is doing exceedingly good work in the district. WATER SUPPLY. In most parts of the country the water supply was a matter of some anxiety during the year, owing to the very dry season, and in many towns it was necessary to curtail the supply, and for the strictest economy to be observed. Fortunately this district was little affected by the shortage. SEWAGE DISPOSAL WORKS. These works still satisfactorily deal with the sewage of the district, the character of the effluent being good. SCAVENGING. The collection of house refuse was carried out weekly, with the exception of Yeading, where fortnightly collections took place. No satisfactoiy tip has been able to be arranged for the deposit of refuse. The only available place is the pits where gravel is extracted for the housing scheme. During the hot weather this tip 6 became a serious nuisance, and was a matter of much complaint. I must impress on the Council that this is most unsatisfactory, and steps should be taken to provide some improved method of dealing with the refuse. COMMON LODGING HOUSES. There are none in the district. OFFENSIVE TRADES. The business of fish frying has been included by the Council as an offensive trade. There are three such businesses in the district permitted by the Council. No complaints have been received as to these. FACTORY AND WORKSHOPS ACT. Thirty-one inspections have been made of factories and workshops, and in each case they were found to be satisfactory. SCHOOLS. There are three elementary schools in the district, but owing to the development of the Housing Scheme, and the increased population, these schools are becoming overcrowded, and I trust no time will be lost by the County Authorities in erecting the proposed new school on the new estate. FOOD. MILK SUPPLY. The standard of the milk consumed in the district continues to be satisfactory. Of retail milk sellers there are ten. all of whom endeavour to obtain satisfactory conditions in their business and whose premises are frequently inspected to ensure that strict attention 15 paid to cleanliness. Through the courtesy of Dr. Young, County Medical Officer, I have received the following 1 eturn of work done during the year by the County Council Inspectors under the Sale of Food and Drugs Act, in this district. List of Samples purchased in the District of Hayes during the year, 1921 :— 7 Article. No. Taken. Adulterated. Milk 33 4 Butter 6 — Cream 5 — Coffee 1 — Lard 2 — Lemonade Powder 2 — Total 49 4 Mr. Palmer, your Sanitary Inspector was, at the beginning of the year, appointed Inspector under the Sale of Food and Drugs Act, and the following samples of food were taken by him during the year: — Article. Taken. Adulterated. Milk 22 2 Butter 10 — Total 32 2 Proceedings were taken in the two cases of adulteration and the cases were dismissed. BAKEHOUSES. There are five bakehouses in the district which have been inspected periodically, and have been found to be generally satisfactory. SLAUGHTER HOUSES. The number of slaughter houses in the district is as follows : — Registered 3 Licensed 2 These slaughter houses are only used at infrequent intervals, and are inspected by your Inspector as far as possible whenever slaughtering is in progress, but owing to the irregular times of slaughtering, which is often done in the evening and over the week-end, a quantity of meat has been placed on the market without 8 previous inspection. On the whole, however, the quality of the meat sold is good. The butchers, fish shops and other food shops are also inspected periodically. During the year the following articles, which were found to be unfit for food, were voluntarily surrendered : — Weight. One side of beef (Foreign) 411 lbs One trunk of fish 84 lbs. 495 lbs. INFECTIOUS DISEASES. The number of Notifications received during 1921 was:— South Ward. East Ward. West Ward. Total. Scarlet Fever 38 6 6 50 Diphtheria 3 — — 3 Pneumonia 1 1 2 4 Ophthalmia Neonatorum 1 — — 1 43 7 8 58 1 he total number of casts again shews a decrease, which is most satisfactory. SCARLET FEVER. Cases notified 50 Deaths — Fatality per cent. — Cases removed to Hospital 45 Fifty cases have been notified during 1921, which is two below the figures of the preceding year. There was no epidemic. The notifications having been spread fairly regularly over the whole year, and the majority of cases were of a very mild type. No. of houses where 1 case occurred 39 „ „ 2 „ 4 „ „ 3 „ 1 Total number of houses where cases occurred 44 9 The following table shews the number of notifications and deaths for the years 1917—1921:— Notifications. Deaths. 1917 7 1 1918 3 — 1919 40 — 1920 52 1 1921 50 — DIPHTHERIA. (Including Membraneous Croup). Cases notified 3 Deaths — Fatality per cent — Cases removed to Hospital 3 This is a considerable decrease compared with the preceding year, when eleven cases were notified. PHTHISIS. Number of deaths 6 Death rate per 1,000 of population .85 The following notifications of Tuberculosis weie received — m 8 (a) Pulmonary F 2 Total 10 M 3 (b) Non-pulmonary F 2 Total 5 The following forms were received under the Tuberculosis regulations Form A 13 Form B — Form C 7 Form D 2 10 OPHTHALMIA NEONATORUM. One notification of the above disease was received, particulars of which are as follows:— Ophthalmia Neonatorum. Notified. Treated at Home. Vision unimpaired. Vision impaired. Total blindness. Deaths. Cases 1 1 1 - - - PNEUMONIA. This disease is still compulsorily notifiable. I have pleasure in stating only four cases were notified, this being a slight decrease compared with the previous year. There were two deaths registered. MEASLES. This disease is not now notifiable and only a few cases were brought to my notice. No deaths were registered. WHOOPING COUGH. One death was registered from this disease. INFLUENZA. During November there was the likelihood of another serious recurrence of this disease, as the number of cases began to assume epidemic proportions. Fortunately, however, although a fairly large number of persons were affected, the disease was of a mild type, and assumed the form of gastro-enteritis. A few persons were inoculated as a preventative. No records are available as to results. The number of deaths registered was two. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. Diphtheria Anti-toxin is supplied by the Council free of charge to the Medical Practitioners in the District. 11 Arrangements are also made with the Clinical Research Association for the examination of any swabs forwarded to them by the Medical Practitioners to be examined and charged to the Council. Twenty-one Reports of such examinations were received during the vear. There being no cases of Small Pox there was no necessity for me to vaccinate anyone during the year. Every house where a case of Infectious Disease was notified, and also where notification of suspected cases were received from the Education Authorities, was visited by your Inspector, and often by myself, and full instructions given to the parents as to precautions to be taken. Disinfectants are freely supplied by the Council, and all infected houses are thoroughly sprayed and disinfected, and if desired bedding is also taken away and disinfected free of expense to the householder. In many instances also the landlords of property have, on the request of the Health Department, had the walls and ceilings of infected rooms stripped and cleansed. HOUSING. Work on the Council's Housing Estate continued during the year, and at the end of that time 414 had been completed and the houses occupied. Only three houses were built by private enterprise. Sanitary Administration and Inspection. The Staff of the Health Department consists of one part time Medical Officer of Health, and one whole time Sanitary Inspector, who is also the designated Housing Inspector, Inspector of Canal Boats, Inspector under the Petroleum Acts, and Inspector under the Sale of Food and Drugs Act. ADOPTIVE ACTS AND BYE-LAWS IN FORCE IN THE DISTRICT. All the adoptive Sanitary and Public Health Acts, including :— Public Health Act Amendment Act, 1890. „ „ „ 1907) Sections 2, 3 and 4. Infectious Disease Prevention Act, 1890. 12 Model Bye-laws relating to:— Dairies, Cowsheds and Milkshops. Nuisances. Drainage. New Streets and Buildings. Tents, Vans, Sheds, etc. INSPECTIONS. Number of Premises Inspected on complaint 51 ,, ,, „ in connection with Infectious Diseases 64 Number of Premises under periodical Inspections 41 Total number of Inspections and Re-inspections 1504 NOTICES. Cautionary and Intimation Notices served 188 Statutory Notices served under the P.H.A., 1875 5 BAKEHOUSES. Number in District 4 ,, of Inspections made 11 SLAUGHTER-HOUSES. Number on Register 5 ,, of Inspections made 111 COWSHEDS. Number on Register 5 „ of Inspections made 12 „ of Milch Cows in the District (approx.) 54 DAIRIES AND MILKSHOPS. Number on Register 6 ,, of Inspections made 24 13 WATER SUPPLY AND SERVICE. Percentage of Houses supplied from Public Service 98.78 Number of Samples obtained for Analysis: From Local Wells 2 Polluted Wells closed i Wells cleansed i DISINFECTION. Rooms Disinfected— Ordinary Infectious Disease 74 ,, ,, Phthisis 9 SUMMARY OF NUISANCES ABATED AND IMPROVEMENTS EFFECTED DURING THE YEAR. Overcrowding abated 57 Houses re-drained 2 Inspection Chambers provided 4 New Drain Ventilating Pipes 1 New Yard Gullies fixed 5 Drains repaired 7 New W.C. Pans and Traps fixed 3 New Flushing Cisterns fixed 8 Flushing Cisterns repaired 22 W.C. Pans and Apartments repaired 34 Stoppages removed from drains 23 Inspection Chambeis repaired 9 Rooms cleansed and repaired 251 Roofs, Gutters and Rainwater Pipes repaired 55 Paving to Yards repaired 31 Dampness remedied 9 Accumulations of Refuse removed 2 Sink Waste Pipes repaired 19 Cesspools emptied 15 New Dust Bins provided 198 Other Nuisances 51 806 14 Housing. I. UNFIT DWELLING HOUSES. I. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 403 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910. 99 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 10 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 146 II. Reinedv of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 122 III. Action under Statutory Powers. A. Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repars 58 (2) Number of dwelling-houses which were rendered fit (a) by owners 43 (b) by Local Authority in default of owners 9 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 5 (2) Number of dwelling-houses in which defects were remedied (a) by owners 5 (b) by Local Authority in default of owners — 15 C. Proceedings under Sections 17 and 18 of the Housing Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders 10 (2) Number of dwelling-houses in respect of which Closing Orders were made 10 (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 11 (4) Number of dwelling-houses in respect of which Demolition Orders were made 9 (5) Number of houses demolished in pursuance of demolition Orders 9 (6) Number of houses demolished without making Demolition Orders — 3. UNHEALTHY AREAS. Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I., or (b), Part II., of the Act of 1890 :— (1) Name of area — (2) Acreag — (3) Number of working class houses in area — (4) Number of working class persons to be displaced — IV. Number of houses not complying with the building bye-laws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 — V. Staff engaged on housing work with, briefly, the duties of each officer One. The Sanitary Inspector. 16 THANKS In conclusion I wish to thank the Council for the ready support afforded me in carrying out my duties, and to Mr. Palmer, your Inspector, for the excellent work he has done in the interests of Public Health. APPENDICES. TABLE 1. VITAL STATISTICS OF WHOLE DISTRICT DURING 1921 & PREVIOUS YEARS. Name of District— URBAN DISTRICT OF HAYES, MIDDLESEX. Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1000Nett Births. Number. Rate Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1916. 5500 ... 118 21.45 ... ... ... ... 3 25.4 46 8.72 1917. 5750 ... 99 17.21 ... ... ... ... 7 70.7 53 9.04 1918. 5750 ... 100 17.39 ... ... ... ... 9 90.0 58 10.08 1919. 5750 104 99 17.2 56 9.74 6 13 11 111.1 63 10.95 1920. 6000 130 127 21.16 47 7.83 13 12 6 47.24 46 7.66 1921. 7000 124 136 19.42 45 6.43 6 13 7 51.47 52 7.43 Area of District in acres 3284 Land At Census Total Population at all ages 6304 (and inland water) 27 Water of 1921 Number of Inhabited Houses 1342 3311 17 TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1921. Notifiable Diseases. CASES NOTIFIED IN WHOLE DISTRICT. Total Cases Notified in each Ward, total casks removed to hospital At all Ages. At Ages— Years. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and Upwards South East West Diphtheria 3 ... 2 1 ... ... ... ... 3 ... ... 3 Scarlet Fever 50 1 8 36 4 1 ... ... 38 6 6 45 Pneumonia 4 ... ... 1 ... 2 ... 1 1 1 2 ... Ophthalmia Neonatorum 1 1 ... ... ... ... ... ... 1 ... ... ... Totals 58 2 10 38 4 3 0 1 43 7 8 48 18 TABLE III. CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1921. Name of District — URBAN DISTRICT OF HAYES, MIDDLESEX. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of "Residents " or "Non-Residents" in Institutions in this District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified 52 Uncertified ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough 1 ... ... 1 ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Influenza 2 ... ... ... ... 1 ... ... 1 ... Erysipelas ... ... ... ... ... ... ... ... ... ... Phthisis Pulmonary culosis 6 ... ... ... ... 3 3 ... ... ... Tuberculosis Meningitis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 2 ... ... 1 ... 1 ... ... ... ... Cancer, malignant disease 5 ... ... ... ... ... 1 3 1 1 Rheumatic Fever 1 ... ... ... 1 ... ... ... ... ... Meningitis ... ... ... ... ... ... ... ... ... ... Organic Heart Disease 5 ... ... ... ... ... 1 2 2 ... Bronchitis 1 ... ... ... ... ... ... 1 ... ... Pneumonia all forms 2 ... ... ... ... ... 1 1 ... 1 Other diseases of Respiratory Organs ... ... ... ... ... ... ... ... ... ... Diarrhoea and Enteritis 6 5 1 ... ... ... ... ... ... ... Appendicitis and Typhlitis ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... Alcoholism ... ... ... ... ... ... ... ... ... ... Nephritis and Brights Disease ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... Other accidents and diseases of Pregnancy and Parturition ... ... ... ... ... ... ... ... ... ... Congenital Debility and Malfor mation, including Premature Birth ... ... ... ... ... ... ... ... ... ... Violent Deaths, excluding Suicide 1 ... ... ... ... ... ... 1 ... ... Suicide ... ... ... ... ... ... ... ... ... ... Other Defined Diseases 20 2 ... ... ... ... 1 6 11 4 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... Totals 52 7 1 2 1 5 7 14 15 6 19 TABLE IV. HAYES MIDDLESEX URBAN DISTRICT. INFANTILE MORTALITY DURING THE YEAR 1921. Nett Deaths from stated causes at various ages under 1 year of age. Cause of Dkath. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3 6 months. 6-9 months. 9 12 months Total Deaths under 1 year. All Causes Certified ... 1 ... ... 1 3 2 ... 1 7 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculosis Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... 1 ... ... 1 ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... Diarrhoea ... ... ... ... ... ... ... ... 1 1 Enteritis ... ... ... ... ... 2 2 ... ... 4 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, and Marasmus ... ... ... ... ... ... ... ... ... ... Other causes ... ... ... ... ... ... ... ... ... ... Totals ... 1 ... ... 1 3 2 ... 1 7