Dup Ken 22 The Royal Borough of Kensington. ANNUAL REPORT (ABRIDGED) OF THE MEDICAL OFFICER OF HEALTH. 1918. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C. Local 614 KEN The Royal Borough of Kensington. ANNUAL REPORT (ABRIDGED) OF THE MEDICAL OFFICER OF HEALTH. 1918. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. Mr. Mayor, Ladies and Gentlemen,— I have the honour to submit the Annual Report of the Medical Officer of Health, which contains a summary of the vital statistics and the sanitary work for the year 1918. The Council have already expressed their appreciation of the ability with which Dr. L. C. Parkes carried on the work in the Public Health Department in my absence during the period under review, and it only remains for me to mention his kind acknowledgment of the assistance he received from the Chief Sanitary Inspector, the District Sanitary Inspectors and the remainder of the Staff of the Department. I have the honour to be, Your obedient Servant, J. E. SANDILANDS. July, 1919. 3 VITAL STATISTICS. Population.—To meet the diminution and abnormal constitution of the population caused by the. war, the Registrar-General has estimated the population of Kensington in 1918 as 173,463 for the purpose of calculating the birth rate, and as 154,814 for the calculation of death rates. Table A. District. Population. Births, Deaths and Rates per 1,000. D. B. Births. Rate. Deaths. Rate. The Borough 154,814 173,463 2,308 13.3 2,751 17.8 North Kensington 79,149 88,686 1,582 17.8 1,592 20.1 South Kensington 75,665 84,777 726 8.6 1,041 13.8 St. Charles 20,427 22,892 407 17.8 378 18.5 Golborne 22,970 25,740 529 20.6 509 22.2 Norland 19,034 21,320 392 18.4 432 22.7 Pembridge 16,718 18,734 254 13.6 273 17.0 Holland 18,204 20,398 157 7.7 245 13.5 Earl's Court 15,830 17,736 231 13.0 256 16.2 Queen's.Gate 12,835 14,380 85 5.9 129 10.0 Redcliffe 17,161 19,228 168 8.7 273 15.9 Brompton 11,635 13,035 85 6.5 138 11.9 Unknown - - - - 118 - Dividing the two populations given for the Borough in 1918 bv the Census population in 1911, which was 172,317, the following factors will be obtained, namely, 1.0067 and 8984. The populations for the various districts in the Borough have been in each case arrived at by multiplying the census population of the district by the second factor to obtain the death rate population shown in the first column of the table, headed "D," and by the first factor, 1.0067, to obtain the birth rate population in the second column, which is headed " B." Births.—The number of births registered was 2,308, after correction for inward and outward transfers. Distributed according to sex and legitimacy the births were as follows:— Male. Female. Total. Legitimate 1,090 1,054 2,144 Illegitimate 91 73 164 Total 1,181 1,127 2,308 The birth rate for the Borough was 13.3 per 1,000 as compared with a rate of 20.0 in the decennium 1901-10. 4 Notification of Births.—Of the registered births 2,165 occurred in Kensington, and of this number 2,114, were notified to the Medical Officer of Health within 36 hours, or at most a few days after their occurrence. The total number of births notified, including still births which are not registerable, was 2,327. Details are given in the following Table:— Source of Notification. Number of Births Notified. Still Births. Live Births. Total Births. Midwives 29 1,235 1,264 Parents 3 189 192 Medical Practitioners 22 486 508 Other Persons 9 204 213 Births in the Borough 63 2,114 2,177 Institutions outside the Borough 7 143 150 Total 70 2,257 2,327 Deaths.—The net deaths belonging to the borough numbered 2,751, and were equivalent to a death rate of 17.8 per thousand, as compared with a death rate of 14.3 in the ten years 1901-10. The mortality in the several wards has already been shown in Table A. The principal causes of death in the several age periods of life are set out in Table III., Appendix. Infantile Mortality.—The deaths among infants under the age of one year numbered 224, the infantile mortality rate being equivalent to 97 per 1,000 births. The following Table shows the mortality among infants in the several wards:— Table B. INFANTILE MORTALITY. District. Deaths under one year. Deaths per 1,000 Births. North Kensington 175 111 South Kensington 49 68 St. Charles 32 79 Golborne 70 132 Norland 45 115 Pembridge 28 110 Holland 12 76 Earl's Court 11 48 Queen's Gate 10 118 Redeliffe 12 71 Brompton 4 47 The Borough 224 97 The principal causes of deaths in the first four weeks and in the later months of infancy will be found in Table IV., Appendix. The same table shows that the mortality amongst illegitimate infants, of whom no less than 42 died, was equivalent to a rate of 256 per 1,000, as compared with a rate of 85 per 1,000 among those born in wedlock. 5 Health Visitors.—The Health Visitors visit infants notified under the Notification of Births Act, cases of ophthalmia in the newly born, infants suffering from tuberculosis and notified cases of puerperal fever. They assist in the work of the voluntary schools for mothers. During the year 1,785 infants were visited shortly after birth and 6,840 visits in all for the purposes mentioned above were made. INFECTIOUS AND OTHER DISEASES. The following Table shows the number of notifications of infectious disease, the number of deaths, and the percentage of deaths to notified cases:— Disease. Number of Notifications. Number of Deaths. Percentage of Deaths to Notified Cases. Scarlet Fever 234 7 3.0 Diphtheria 163 11 6.7 Enteric Fever 11 1 9.1 Erysipelas 48 5 10.4 Cerebro-Spinal Meningitis 14 6 42.9 Measles 845 14 8.6 German Measles 240 - - The age period of cases notified and the ward distribution will be found in Table II., with the age period of deaths in Table III., Appendix. Diarrhoea.—57 deaths were registered as due to Diarrhoea or Enteritis, 36 of which occurred during the first year of life. Small Pox.—No case of Small Pox occurred in the Borough during the year. Thirtyseven cases were notified in London. Puerperal Fever.—Only four cases were notified during the year, the average annual number being ten. There was no death from puerperal fever. Ophthalmia Neonatorum.—Twenty-eight cases of ophthalmia in newly born infants were notified during the year. Tuberculosis.—Three hundred and thirty-six persons were notified for the first time as suffering from tuberculosis of the lungs; and 96 as suffering from other forms of tuberculosis. The following tables set out the Deaths from Tuberculosis and Death Rates per 1,000 of the population, the distribution of the notified cases in the several wards of the Borough, and the Forms of Tuberculosis in the persons notified:— Deaths from Tuberculosis and Death Rates per 1,000. Tuberculosis of Lungs. Other Tuberculous Diseases. Tuberculosis—All Forms. Deaths. Death Rate. Deaths. Death Rate. Deaths. Death Rate Annual Average 1911-1915 179 1.04 60 0.35 239 1.3 1918 203 1.31 47 0.30 250 1.61 6 Notified cases of Tuberculosis in Wards. District. Tuberculosis of Lungs. Other Forms. All Forms. North Kensington 249 82 331 South Kensington 87 14 101 St. Charles 57 22 79 Golborne 74 27 101 Norland 77 22 99 Pembridge 41 11 52 Holland 32 3 35 Earl's Court 15 5 20 Queen's Gate 21 2 23 Redcliffe 13 3 16 Brompton 6 1 7 The Borough 336 96 432 Forms of Tuberculosis in Persons Notified. Site of Disease. Number of Cases. Lungs 336 Larger joints and bones above wrist and ankle 13 Lymphatic glands other than mesenteric 37 Vertebral column (Spine) 4 Smaller joints and bones of wrist, ankle, hand, foot 8 Mesenteric glands, bowel, peritoneum 21 Meninges of brain 7 Skin 4 Other parts 2 Total cases 432 Cancer.—The deaths from cancer numbered 206; males 77, and females 129. FOOD SUPPLY. Milkshops.—At the end of the year there remained on the Council's Register 184 premises where milk was sold. Of these premises 118 were milkshops, 33 were general shops and 33 were restaurants. Cowsheds.—The licence of the only cowshed in the Borough was renewed by the London County Council for ten cows. The number kept does not as a rule exceed four. Ice-cream.—At the end of the year 189 premises were shown in the Register of places where ice-cream is prepared or sold as compared with 190 premises at the end of the preceding year. Bakehouses.—There are 86 bakehouses in the Borough, and of this number 64 are underground. Slaughter-houses.—Six slaughter-houses were licensed by the London County Council in October. Special conditions as to notice and hours of slaughtering attach, as reported in 1916, to the licence of the house in the Walmer Road, where a considerable number of pigs are killed. 7 Other Premises Used for Sale, &c., of Food.—These premises are entered in a Register under the date on which they were finally inspected and found to comply as regards structure with the sanitary regulations in S. 8 of the London County Council (General Powers) Act, 1908. At the end of the year the following shops or premises remained on the Register, namely:— Provision Dealers 282 Restaurants. 169 Butchers' Shops. 97 Fried Fish Shops. 22 Fishmongers. 49 Greengrocers. 101 Other Shops. 15 Unsound Food.—The unsound food surrendered and destroyed during the year is shown in the following list:— Beef Hind qtrs. (stones) 63 Beef Brisket (stones) 10½ Beef Fore qtrs. (stones) 23 Beef Top side, thick flank and rump (lbs.) 64 Beef Ribs (lbs.) 4½ Beef Buttocks (stones) 10 Beef (lbs.) 8 Sheep Carcases 4 Cows' Carcases with organs (tuberculous) 2 Ox Liver (lbs.) 15 Tainted Meat (lbs.) 3½ Veal Loin (lbs.) 24 Veal Fore qtrs. (stones) 10 Pigs' Heads (tuberculous) 5 Pigs' Carcase and pluck (tuberculous) 1 Pigs' Liver, Lungs and Kidneys Bacon (lbs.) 29 Bacon, Shoulders of (lbs.) 119 Pork (lbs.) 36 Meat (tins) 1 Rabbits (boxes) 2 Cod, 1 box of (lbs.) 56 Herrings, 1 box of (stones) 6 Haddocks (stones) 3 Butter Beans (lbs.) 14 Potatoes (tons) 3½ Sale of Food and Drugs Acts.—During the year the Sanitary Inspectors collected 701 samples under the above Acts and submitted them to the Public Analyst for analysis. Of the samples submitted 69, or 9 per cent., were reported as adulterated. Proceedings were taken in 18 cases for adulteration or other offences, the fines and costs inflicted amounting to £77 1s. 6d. HOUSING OF THE WORKING CLASSES. Lodgings provided by the Council.—The Council provide within the Borough 120 tenements of one, two, or three rooms for the working classes. Latterly all the Council's tenements have been let. Houses Let in Lodgings.—The number of houses let in lodgings on the Council's register at the end of the year was 2,065. In 1913, 187 of the registered houses were let in furnished lodgings at a charge of 1s. per night per room. The lodgings in the remainder of the registered houses are let unfurnished. The inspections and re-inspections of lodging houses numbered 4,988. Notices requiring the remedy of defects found were served in 346 instances, and 15 cases of overcrowding were abated. The owners of four lodging houses were summoned for failing to carry out sanitary repairs and for breach of by-laws for houses let in lodgings. 676 houses were reported as having been cleansed in accordance with the requirements of By-Law 16. Common Lodging Houses.—The Common Lodging Houses in the Borough number 17 and contain accommodation for some 545 persons. Eight are for male and 9 for female lodgers. Housing (Inspection of District) Regulations, 1910.—The house-to-house inspections for the purpose of these Regulations and the detection of nuisances numbered 703. This figure does not include re-inspections, inspections on complaint or inspections of registered lodging houses for the purpose of enforcing the lodging house by-laws. In accordance with the directions in the Local Government Board Circular of 4th August, 1915, only urgently necessary work has been required, with the result that it has not been possible to proceed with the scheme of housing work which had been instituted on the lines laid down in the regulations. 8 Inland Revenue Acts.—Under these Acts 26 certificates were issued by the Medical Officer of Health, in respect to 38 tenements in 13 houses containing a total number of 39 separate dwellings. Water Supply to New Houses.—No inspections of newly-erected houses were made during the year for the purpose of certification before occupation as having a proper and sufficient supply of water. Remedy of Defects,—A tabular statement showing in detail the work carried out under the direction of the Sanitary Inspectors for the remedy of various sanitary defects in dwelling houses is entered month by month and for the year in the registers of the Public Health Department. The registers are available for reference and render the publication of a detailed statement in the Annual Report unnecessary. In eight cases legal proceedings were instituted against persons who had failed to comply with the sanitary requirements of the inspectors. Fines amounting to £4 were inflicted. FACTORIES AND WORKSHOPS. The Council is required to keep a register of workshops and is responsible for the sanitary conditions of all workshops and workplaces in the Borough. For the sanitary condition of factories the Home Office is directly responsible, the duties of the Council in factories being limited to securing the provision of suitable and sufficient sanitary conveniences for the persons employed. Where women are employed the inspections are made by the Council's Lady Sanitary Inspector. The following list shows the number of workshops and factories in the Borough. (A) Premises on which female labour is employed— Workshops. Factories. Dressmakers and ladies' tailors 355 4 Laundries142 60 Other premises 233 12 Total (A) 730 76 (.B) Premises on which female labour is not employed— Bakehouses86 14 Bootmakers 170 7 Builders 117 9 Tailors 111 0 Printers 0 22 Other Premises 536 110 Total (B) 1020 162 Workshops and factories in the Borough 1750 238 Home Work.—The following figures show the approximate number of out-workers and home-workers in the Borough:— Out-workers in workshops and factories 116 Out-workers in domestic workshops 34 Out-workers in their own homes 184 Total out-workers 334 The number of out-workers' lists received were as follows:— Number of Lists. Number of Names thereon Once in the year 28 337 Twice in the year 36 325 Totals 64 662 9 SANITARY WORK Sanitary Inspectors (Male).—The last monthly report of the Medical Officer of Health for the year 1918 sets forth in tabular form the principal items of the work of the male sanitary inspectors during the year. The same return in greater detail, showing the number of inspections made, the sanitary notices issued and the sanitary works completed, is available for reference in registers kept for the purpose in the Public Health Department. Lady Sanitary Inspector.—A summary of the monthly reports shows that the Lady Sanitary Inspector who worked single handed during the year (Miss de Chaumont having rejoined the Nursing Service, in July, 1917) paid in all 1,690 visits—664 to factories and workshops, 854 to cases of tuberculosis, and 172 for other purposes. Disinfection.—The disinfecting staff disinfected 1108 rooms in 960 tenements or dwelling houses. The bedding from 787 households was disinfected by steam or by washing and boiling at the disinfecting station at Wood Lane. The number and weight of the articles dealt with was as follows:— Articles disinfected only 7,836 Articles disinfected and washed 594 Total number of articles 8,430 Total weight of articles 28 tons 4 cwt. Verminous Persons.—The following table shows the number of persons dealt with at the Council's Cleansing Station during the year:— Children cleansed 1,351 Adults cleansed 178 Number of baths given 4,709 Verminous Rooms.—258 verminous rooms were cleansed in response to notices, 3 verminous beds were destroyed and 54 dirty beds were cleansed. In addition 139 beds were disinfected by steam at Wood Lane and 119 verminous rooms were fumigated by the Council's disinfecting staff. Rag Flock.—No samples of rag flock were taken during the year. Mortuary.—During the year 233 bodies were deposited at the Mortuary. In 96 cases post-mortem examinations were made and 168 bodies were deposited for the holding of inquests at the instance of the coroner. 65 bodies were deposited in the Chapel of Rest. 10 APPENDIX. Local Government Board Tables I—IV TABLE 1. Vital Statistics of Whole District during 1918 and previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belong ng 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. Number. Rate per 1,000 Nett Births Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1913 171,700 3,173 3,335 19.4 2,614 15.2 695 490 371 111 2,409 14.0 1914 171,400 3,019 3,153 18.4 2,624 15.3 767 432 298 95 2,289 13.4 1915 †55,795 2,917 3,074 19.7 3,100 19.9 942 493 365 119 2,636 16.9 1916 ‡165,535 B 152,144 D 2,861 3,027 18.3 3,183 209 1,275 429 258 85 2,337 15.4 1917 ‡ 168,019 B 151,535 D 2,201 2,378 14.8 3,280 21.6 1,329 523 309 130 2,474 16.3 1918 ‡173,463 B 154,814 D 2,220 2,308 13.3 3,735 24.1 1,508 524 224 97 2,751 17.8 * Rates calculated per 1,000 of estimated population. † Civil Population as estimated by the Registrar-General, and upon which the rates in this year are based. ‡ B. Population as estimated by the Registrar-General for the calculation of Birth rate. D. ,, ,, ,, ,, ,, ,, ,, Death rate. Area of District in acres (exclusive of area covered by water) 2291 At Census of 1911. Total population at all ages 172,317 Total families or separate occupiers 38,118 11 TABLE II. Cases of Infectious Disease notified during the Year, 1918. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. Total Cases Removed to Hospital. At all Ages. At Ages.—Years. St. Charles. Golborne. Norland. Pembridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Brompton. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ••• ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ••• ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 163 4 61 63 22 9 3 1 29 34 29 14 19 14 10 10 4 148 Erysipelas 48 2 ... 2 3 12 17 12 7 10 5 6 3 3 7 6 1 14 Scarlet fever 234 2 75 110 38 8 1 ... 47 71 56 17 14 5 6 14 4 206 Typhus fever ••• ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 11 ... ... 2 2 5 2 ... 1 ... ... ... 1 1 5 1 2 11 Continued fever 2 ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... 1 ... 2 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 4 ... ... ... ... 4 ... ... ... 2 ... 1 1 ... ... ... ... 2 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Meningitis 14 ... 4 3 1 4 1 1 5 1 3 ... 1 ... 2 2 ... 11 Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 336 ... 1 82 63 136 47 7 57 74 77 41 32 15 21 13 6 270 Other forms of Tuberculosis 96 1 22 48 10 11 2 2 22 27 22 11 3 5 2 3 1 36 Ophthalmia Neonatorum 28 28 ... ... ... ... ... ... 7 9 3 5 3 ... ... ... 1 2 Measles 845 32 366 319 75 48 4 1 70 112 95 98 96 75 81 169 49 48 German Measles 240 7 35 93 55 45 5 ... 18 6 21 36 66 40 25 18 10 16 Totals 2021 76 564 722 269 283 83 24 263 346 311 230 239 158 159 237 78 766 12 TABLE III. Causes of, and Ages at, Death during the Year 1918. Causes of Death • Nett Deaths at the subjoined ages of" Residents " whether occurring within or without the 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. All causes Certified 2,751 224 107 122 Ill 167 474 621 925 Uncertified - - - - - - - - - Enteric Fever 1 ... ... ... ... 1 ... ... ... Small-pox ... ... ... ... ... ... ... ... ... Measles 14 1 8 4 ... ... ... ... 1 Scarlet Fever 7 ... 2 5 ... ... ... ... ... Whooping-Cough 36 9 14 11 2 ... ... ... ... Diphtheria, and Croup 11 ... 1 3 6 ... ... ... 1 Influenza 336 2 7 15 20 50 143 58 41 Erysipelas 5 2 ... ... ... ... ... ... 3 Phthisis (Pulmonary Tuberculosis) 203 ... ... 2 11 39 80 61 10 Tuberculous Meningitis 18 ... 3 9 4 2 ... ... ... Other tuberculous diseases 29 1 1 5 10 5 3 3 1 Cancer, Malignant disease 206 ... 1 ... 1 ... 14 100 90 Rheumatic Fever 6 ... ... ... 1 3 1 1 ... Meningitis 29 7 5 4 4 2 5 2 ... Organic Heart Disease 218 ... ... ... 3 6 26 61 122 Bronchitis 278 23 9 2 3 2 18 57 164 Pneumonia (all forms) 416 39 44 49 25 36 90 65 68 Other diseases of Respiratory Organs 33 ... 1 2 1 2 2 11 14 Diarrhoea and Enteritis 57 36 7 1 ... ... 1 5 7 Appendicitis and Typhlitis 10 ... ... ... 2 3 1 4 ... Cirrhosis of Liver 14 ... ... ... ... ... 2 4 8 Alcoholism ... ... ... ... ... ... ... ... ... Nephritis and Bright's Disease 67 ... ... ... 1 2 7 26 31 Puerperal Fever ... ... ... ... ... ... ... ... ... Other accidents and diseases of Pregnancy and Parturition 4 ... ... ... ... 2 2 ... ... Congenital Debility and Malformation including Premature Birth 75 73 1 1 ... ... ... ... ... Violent Deaths, excluding Suicide 66 5 ... 6 5 3 11 15 21 Suicide 21 ... ... ... ... ... 11 9 1 Other Defined Diseases 590 26 3 3 12 9 57 138 342 Diseases ill-defined or unknown 1 ... ... ... ... ... ... 1 ... 2,751 224 107 122 111 167 474 621 925 13 TABLE IV. INFANT MORTALITY DURING THE YEAR 1918. Nett Deaths from stated Causes, at Various Ages, under One Year of Age. Cause of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Causes. Certified 53 11 8 6 78 42 42 37 25 224 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... 1 1 2 3 2 9 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... 1 1 ... 2 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... 1 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... 1 2 2 2 7 Convulsions ... ... ... ... 1 ... ... ... 1 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis 1 ... ... ... 3 7 6 6 1 23 Pneumonia (all forms) ... ... ... ... ... 7 7 18 7 39 Diarrhoea ... 1 ... ... 1 1 1 1 1 5 Enteritis 1 3 ... ... 4 6 13 4 4 31 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 4 1 ... ... 5 Rickets ... ... ... ... ... ... ... ... 1 1 Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... Injury at birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 1 ... ... ... 1 1 ... ... ... 2 Congenital Malformation 2 ... ... ... 2 2 1 ... ... 6 Premature Birth 20 3 3 1 27 1 1 ... ... 29 Atrophy, Debility, and Marasmus 20 3 2 4 29 7 3 1 1 41 Other causes 6 1 ... ... 7 4 4 ... 4 19 53 11 8 6 78 42 42 37 25 224