WIM 049 URBAN SANITARY DISTRICT OF WIMBLEDON, COUNTY OF SURREY. Report of the Medical Officer of Health For the Year ending December 31st, 1897. Wimbledon Urban District Council. Report of the Medical Officer of Health FOR THE YEAR^ ENDED 31ST DECEMBER, 1897. Births. Gentlemen, I have the honour to present my Annual Report for the year ended the 31st December, 1897. The total number of births registered was 828 (433 males, 395 females), which is 47 less than last year, equal to a birthrate of 23 65 per thousand per annum, which is 2-86 lower than last year. The birth-rate in England and Wales, for the same period, is given at 29'7 in the report of the Registrar General. Deaths. The total number of deaths registered was 367 (194 males, 1 73 females), equal to a death-rate of 10 4 per thousand living per annum; taking the population at 35,000 (the estimated population at Midsummer, 1897). After making the usual corrections as indicated at the bottom of Table 3. The total number of deaths properly belonging to the district is found to be 398, and the death-rate 11.3. The death-rate for England and Wales for the same period is given as 17 4. The deaths which occurred outside the district among persons belonging thereto which have come to my knowledge were 2 2 at Brookwood Asylum, and 31 at Kingston Infirmary. The deaths which occurred within the district among persons not belonging thereto which have come to my knowledge were 2 in Atkinson Morley's Hospital. Infant mortality is represented by a ratio of 118 deaths under one year of age to 1,000 registered births, as against 156 deaths per 1,000 births in England and Wales for the same period. This rate varies very much with the diarrhœal mortality and the increasing number of deaths from measles. Between the ages of 1 and 60 there were 175 deaths, and 94 deaths of persons aged 60 years and upwards. The death-rate from all Zymotic diseases was 2 0 per thousand of the population per annum. Influenza caused 4 deaths, against 4 last year, 14 in 1895, 10 in 1894, and 20 in 1893. There were 20 deaths from bronchitis, 21 from pneumonia and 17 from phthisis, (see Table 6, in w hich is classified the whole of the deaths as to their causes and ages). In column 1 will be seen the chief causes of mortality among the 98 infants who died during the year. Comparing the deaths from Respiratory diseases with those that occurred last year it is satisfactory to note a slight improvement. The number of deaths from Zymotic diseases (including Influenza) was 70, viz.: from Measles 16; Scarlet Fever 2; Diphtheria 6; Diarrhoea 29; Whooping Cough 7; Enteric Fever 1; Puerperal Fever 1; Erysipelas 2; Influenza 4; Membranous Croup 1; Septicaemia 1. Table A shows for the last year and the four preceding years the births, deaths, death-rates, and the deaths at certain ages, and from specified causes. 3 Table B shows for the same years the number of infectious cases notified, and the deaths from each notifiable disease. Table C shows the death-rate from Zymotic diseases for the last 10 years. TABLE A 1897 1896 1895 1894 1893 Births 828 875 857 794 780 Deaths 367 343 377 310 363 Death-rates 11.3 11.06 121 10.3 12.9 DEATHS— Under 1 year 98 97 102 81 107 Over 1 year and under 60 years 175 150 174 147 166 Above 60 years 94 96 101 82 90 From Measles 16 9 2 6 5 ,, Scarlet Fever 2 2 0 0 3 ,, Small Pox 0 1 0 0 0 ,, Diphtheria 6 3 16 10 3 ,, Diarrhoea 29 13 15 6 16 ,, Whooping Cough 7 15 23 8 1 „ Enteric Fever 1 3 1 3 0 ,, Puerperal Fever 1 2 1 0 6 „ Erysipelas 2 0 1 1 2 ,, Influenza 4 4 14 10 20 „ Membranous Croup 1 0 2 0 1 4 TABLE 33. DISEASES. 1897. 1896. 1895. 1894. 1893. Cases Notified Deaths Cases Notified Deaths Cases | Notified Deaths Cases Notified Deaths Cases Notified Deaths Small Pox 0 0 2 1 1 0 1 0 21 0 Puerperal Fever 5 1 5 2 1 1 0 0 11 6 Diphtheria 41 6 30 3 37 16 43 10 37 3 Membranous Croup 2 1 0 0 2 2 1 0 2 1 Scarlet Fever 155 2 124 2 76 0 93 0 294 3 Enteric Fever 17 1 10 3 14 1 13 3 16 0 Erysipelas 44 2 35 0 33 1 45 1 79 2 Measles 0 16 0 9 0 2 0 6 0 5 Totals 264 29 206 20 164 23 196 20 460 20 TABLE C. Zymotic Rate. 1897 1896 1895 1894 1893 1892 1891 1890 1889 1888 20 1.63 2.03 1.50 2.03 1.7 1.15 0.62 1.18 0.81 Scarlet Fever. This disease has been present during the whole of the year. It prevailed extensively during the months of January, February, October and November. There has been a large number of cases in the Metropolis, and many of the cases notified in the district were imported from London. The disease has been of a mild type, and only two deaths were registered from it during the year, one of which occurred at the Infectious Diseases Hospital, the other at the patient's home. The total number of cases notified was 155, of which 94 were treated in the Infectious Diseases Hospital and the remainder in their own homes. The proportion amongst 5 adults is small, and this gives confirmation to the statement that Scarlet Fever is not a disease of adult life; and this, not because it has been had 'in childhood, as the greater number of children escape it. In this fact lies the strongest inducement to persevere in the efforts which have been made by isolation, and otherwise to diminish the spread of the disease, for it is not necessary to have it in childhood, and childhood escaped, the risk of having it at all is greatly diminished, every year of life giving increased immunity. An outbreak occurred among the scholars of the Central Schools in the Autumn, when I considered it would be desirable that those schools should be closed for a period, and disinfected, but a sudden decrease in the cases caused me to change my mind, and the removal from the school of a boy who was discovered to be peeling had the effect of stopping the further spread of the disease. It was found necessary to provide additional Hospital accommodation in the form of a Hospital Marquee, capable of accommodating 16 patients, as previous to the erection of the Marquee several cases of Scarlet Fever were refused admission, as the Iron Hospital was full. The parents of many of the children who were attacked have not exercised sufficient care in calling in medical aid, and so desquamation has begun, and the disease spread before the case had been discovered and isolated. The Masters and Mistresses of the schools have been notified whenever a case has occurred among their scholars, and the other children in the houses in which the cases have occurred have been kept away from school. Compensation was given to Laundresses whose businesses were stopped on account of fever occuring in their houses. Diphtheria. Forty-one cases were notified during the year, and six deaths registered, against thirty cases in the preceding year, and three deaths. A great many of these cases were imported from other districts, and three cases were notified from 6 Atkinson Morley's Hospital, to which institution they had been sent from St. George's Hospital, London. The cases and deaths were divided among the age periods as follows: 0—5 years, eight cases and one death; 5—15 years, twenty-six cases and four deaths; 15—25 years, two cases and no deaths; 25—35 years, two cases and no deaths; 35—45 years, two cases and no deaths; 45—55 years, one fatal case. The increase of Diphtheria in its prevalence and fatality is a matter of serious importance, and there is little satisfaction felt in the fact that the increase is not confined to Wimbledon, but is also the case in London and the suburbs generally. Doubtless a large number of cases of a mild type occur without characteristic signs, and are not recognized. These may carry infection. A Bacteriological examination is necessary in many cases to determine a diagnosis, and the Council at my suggestion have become subscribers to the Clinical Research Association, who supply tubes for procuring samples of diphtheria membrane for analysis. The medical men in the district have been informed that the tubes can be had at the Council offices, and an examination made free of cost, so that if any suspicious cases come under their notice they may have an examination made. Few of the medical men have availed themselves of this privilege so far. Of the forty-one cases notified twenty-one attended schools, viz.: two the High School; six Holy Trinity Schools; six Haydon's Road Schools; four the Central Schools; three private schools. At only five of the thirty-six houses in which Diphtheria occurred were the drains and sanitary arrangements found to be in a bad condition, and at three of these houses the cases were fatal. It is a difficult matter to combat this dangerous disease, as so little is apparently known of its origin. Sewer gas, bad drains, and wet sites are no doubt predisposing causes; and school attendance may be responsible for its spread, but this is not so in Wimbledon, and as far as I can discover there is no factor common to the cases. r Typhoid Fever. Seventeen cases were notified, and one death occurred against ten last year and two deaths, and fourteen in 1895 and one death. No cases occurred in April, June, August and October. Two cases occurred in February, two in March, three in May, three in September, four in November, and one in each of the three remaining months (see Table 2). The fatal case occurred in February at a house in Pelham Eoad, a gentleman, aged 58 years, who contracted the disease in London. Four of the cases (notified by one medical man) were infants aged respectively two years, one year, eleven months, and eight months. At most of the houses where the cases occurred the drains and sanitary arrangements were found to be in good condition, and free from defects. At those premises whore defects existed, notices were served on the owners and the defects remedied, and in all cases special attention was given to the cleansing and disinfection of drinking water cisterns. I have not been able to discover any cause to account for the increase of the disease. The small percentage of deaths goes to prove that the disease was not of a very serious nature, and in my experience the occurrence of the disease in infants a few months old is quite unusual, except in cases of epidemics. Measles. As will be seen by Table B there were 16 deaths from Measles, while there were only thirteen deaths in the year from all the notifiable diseases. Measles is therefore responsible for three more deaths than all the notifiable diseases together In previous reports I have strongly advised the compulsory notification of this disease, so that preventive measures may be taken. I am well aware what the notification of this disease implies; viz.: notification fees to medical men, extra duties, and perhaps additional staff, etc.; but notwithstanding I think the Council should take some steps to try if possible to check the spread of a disease which has proved so deadly amongst the young children in this district. 8 A severe epidemic of Measles occurred among the scholars of the Haydon's Road Schools in November, and on my recommendation the schools were closed for a limited period, followed by the Christmas holidays. On the opening of the schools in January this year it was evident that the disease had greatly subsided, but while it continued in November and December, the whole of the 16 deaths registered occurred, and no deaths occurred in any other month of the year from Measles. The deaths were divided among the age periods as follows: 0—1 year, one death; 1—5 years, thirteen deaths; 5—15 years, two deaths. The following is an extract from my Annual Report for 1892, to which I also called attention in my report for last year:— "As Measles is one of the most infectious of diseases, and causes as great a mortality as any of those notifiable, I think it would be advisable for the Local Board to avail themselves of the provisions under the Infectious Diseases Notification Act, and make an order to include Measles among the diseases already notifiable in the district. With our present Hospital accommodation Isolation would of course be out of the question, but the masters and mistresses of schools might be informed of any cases occurring among their scholars, or among the inmates of houses from which their scholars attend, with a view to preventing children attending from such houses until a certificate be produced from a medical man stating that the premises are free from infection. It would be a good plan to give this a trial for a specified time, and if it were found to be of no use, the order could be revoked." Erysipelas. Forty-four cases of Erysipelas were notified, and two deaths were attributed to this disease. It is hard to see what advantage results from the requirement of notification of these cases. I think if Erysipelas was struck off the list of notifiable diseases, and Measles substituted, the advantage would soon become apparent. 9 Membranous Croup. Two cases from this disease (which is practically synonymous with Diphtheria) were notified, and one proved fatal. At both houses the sanitary arrangements were in good condition. Diarrhoea. Nearly all the deaths from Diarrhoea occurred between the end of July and the beginning of September. The age incidence of the fatal cases which occurred during the year was as follows: 0—1 year, twenty-four; 1—5 years, three; 45—55 years, one; 55—65 years, one; total 29. This number does not include nine deaths from Enteritis (which is a diarrhoeal disease), all of children under five years of age, and eight of which were under one year. The essential condition to an epidemic of "summer diarrhœa" was present in a high temperature during July and August. The rainfall in July was .97, and in August 3 23. Table A on page 3 shews at a glance the deaths from Diarrhoea for the past five years. Whooping Cough. Whooping Cough caused seven deaths, as against fifteen in 1896, and twenty-three in 1895. Puerperal Fever. Five cases were notified, and one proved fatal. In all cases the nurses were written to and prevented from attending other midwifery cases for a period of six weeks after the date of their last attendance. In some cases the Council compensated the midwives who were prevented from following their occupation. Small Pox. A suggestion made by the Corporation of Croydon for the formation of a Joint (Small-pox) Hospital Board for the Borough of Croydon, the Rural District of Croydon, and the Urban District of Wimbledon, was approved of by the Council. A Local Government Inquiry was held at the Croydon Town Hall on the subject. The was no opposition, and a draft of the proposed Provisional Order constituting the Joint Board was submitted to the Authorities concerned by the Inspector for their consideration. Infectious Diseases Hospital. During the year 96 patients were admitted to the Hospital suffering from Scarlet Fever. One case proved fatal. 10 Two of the cases were admitted from Singlegate, Merton, with the sanction of the Council. A marquee was erected in October in the grounds of Durnsford Lodge. I have alluded to this on page 5 , under the heading of "Scarlet Fever." Disease. Age. January. February. March. April. May. June. July. August. September. October. November. December. Total. The following Table shows the cases of Scarlet Fever admitted to the Hospital during each month of the year. Scarlet Fever Under 5 2 4 0 0 3 0 1 0 1 4 1 0 16 5 upwards 7 5 3 5 5 0 3 7 6 16 19 4 80 Total ... All ages 9 9 3 5 8 0 4 7 7 20 20 4 96 11 There is no provision at present for the treatment of any other diseases but Scarlet Fever, but there is now good prospect of having suitable Hospital accommodation within no distant period. The following is the scale of fees payable for the maintenance of patients in the Hospital:— per week. Where the rateable value of the house does not exceed £20 Nil. Exceeds £20, and does not exceed £30 10/„ £30, „ „ £40 15/„ £40, „ „ £50 21/„ £50 42/- Servants sent to the Hospital by employers are charged for according to the rateable value of the employers' houses, but with a maximum of £1 . 1. 0 per week. In several cases the fee is remitted if it is thought desirable by the Council to do so. Disinfection. The following Table shows the number of articles disinfected in the hot air chamber after each disease. Diseases. Mattresses. Palliases. Beds. Pillows and Bolsters. Blankets. Dresses. Suits. Other Articles. Totals. Scarlet Fever 25 80 153 294 291 7 18 2432 3300 Diphtheria 7 12 31 74 54 2 15 357 552 Typhoid Fever 3 ... 3 6 3 ... ... 7 22 Infantile Diarrhœa ... ... 2 3 ... ... ... 10 15 Totals 35 92 189 377 348 9 33 2806 3889 12 Proposed New Hospital. The number of rooms disinfected was 155. Six library books were disinfected. On the 30th October and 2nd November, 1896, Dr. Sweeting, one of the Medical Inspectors of the Local Government Board, held an inquiry into the Council's application for a loan of £10,000 for the erection of the proposed New Hospital in the upper Cemetery field. There was considerable opposition to the site by the owners of the adjoining property, several of whom were represented by Counsel. The inquiry lasted two days, and Mr. Macmorran, Q.C., conducted the Council's case. The Local Government Board wrote to the Council on the 23rd Feb. 1897, stating that they would accept the upper Cemetery field as the site for the New Hospital, subject to the sanction of the Home Secretary being obtained to the proposed appropriation to burial purposes, in lieu of the upper Cemetery field, of land at the rear of the Cemetery, at present forming part of the Sewage Farm. The application for the sanction of the Home Secretary was made, and this sanction has been obtained. An action was commenced by the Land Securities Company Ltd. for an injunction to restrain the Council from proceeding with their scheme. This action is still pending. Plans were prepared by the Surveyor and submitted to the Local Government Board for their approval, and this has not yet been obtained. Housing of the Working Classes Act, 1890. In January a complaint was made respecting a dilapidated cottage in Beulah Road, and the Committee decided to serve a notice under this Act on the owner. The notice had the desired effect, and the cottage was put into a proper state of repair. The houses Nos. 1 to 23, Berckley Road, which were closed under the Act last year, were also thoroughly done up and re-drained. The whole of the sites were concreted, new flooring laid, roofs and walls repaired, new W.C.'s built, and new sanitary appliances fixed. All the houses are now again occupied. 13 A notice was served in July on the owner of the Sandwashing premises in Plough Lane, under Sec. 32 of the Act. The following was the Inspector's report on the promises:— "I examined these premises this morning (July 19th), and found that the field adjoining the house is swamped with sewage from privy-pits, staples and sand-washing effluent. The sewer in Plough Lane is 129ft. distant from the nearest point of the house, so that although there is no drain sufficient for the effectual drainage of the premises, the case cannot be dealt with under Sec. 23 of the Public Health Act, 1875, as the distance is limited in that section to 100 feet. I suggest that the best way to deal with the case is under Sec. 32 of 'The Housing of Working Classes Act, 1890.' The cost of properly draining the premises would be almost as much as the house is worth. The house is in a very dilapidated state, and certainly unfit for habitation. The walls are of wood and plaster, faced with weather-boarding, and the thickness of the walls throughout is about 4½ inches. The ceilings are falling, and the flooring is very shaky. The roof is leaky, and there is no proper guttering. The privy-pits are situated outside the back door, and discharge into a ditch in the field adjoining the Plough Larie. All the waste water and washing water also goes into this ditch. The drainage from the stables and sand-washing have converted the whole of the ground surrounding the house into a malarial marsh, and I consider steps should be taken to stop Mr. Woodley's business as soon as possible." Certain work was carried out with regard to the cottage, but nothing was done to remedy the insanitary condition of the surroundings, and a closing order was applied for on Nov. 3rd. The Bench allowed the case to be adjourned for a month, the defendant's solicitor agreeing for his client to take the necessary steps to meet the wishes of the Council. A specification of the work required to be done was forwarded to the occupier, and this specification he declined to carry out. The Bench held that the Act under which the proceedings 14 were taken out did not apply, and dismissed the case with £'1.2.0 costs and 12/6 court fees. The following is the definition of a dwelling house under "The Housing of the Working Classes Act, 1890." Sec. 29, Sub. Sec. 2. "The expression 'dwelling house' means any inhabited building, and includes any yard, garden, out-houses and appurtenances belonging thereto, or usually enjoyed therewith, and includes the site of the dwelling house so defined." The defendant was summoned in the previous summer for polluting a stream in Plough Lane, but the summons was withdrawn on the defendant undertaking to do what was necessary to prevent a continuance of the pollution. This undertaking meant that the whole of the effluent from the Sand-washing works would have to be treated on a small field, and this has been done with the result that a serious nuisance exists, and one that may prove injurious to the health of persons in the neighbourhood. Before this happens an injunction should be applied for in the High Courts (as in a similar case) as Police Court proceedings seem to be of little avail. Factory and Workshops Act. Several of the Workshops have been examined, some on complaint from Her Majesty's Inspector of Factories. At four Laundries there was no provision for carrying off the steam. Notices served on the owners to provide means of carrying off the steam were complied with. At three Workshops new w.c. accommodation was provided under notice from the Inspector, and at another Workshop water was laid on from the Company's main. Overcrowding Nine bad cases of overcrowding were abated without the aid of legal proceedings, but the nuisances were only abated 15 as far as the houses complained of were concerned. I spoke strongly on the subject of overcrowding in my last year's report. This is due chiefly to the very high rents demanded by owners of Cottage Property. It is a usual thing for the owner to put up his rents after being called on by the Council to carry out some necessary sanitary improvement. A houseto-house inspection should be made with a view to taking action against the owners of overcrowded houses. This would probably have the effect of having the rents reduced, and so placing them within the means of a single family. For some reason there has been a large influx of poor persons from Battersea; whether the lavish distribution of charity in the district during the winter months has anything to do with it I cannot say. Dairies The Dairies, Cowsheds and Milkshops have been inspected. There are 42 of these premises in the District, three having been registered during the year. A Cowshed, containing 50 cows, was abolished, as being unfit for the purpose of cow-keeping, and the cows were removed to a shed outside this District. Milkmen supplying houses in which cases of infectious disease occurred were cautioned against leaving milk tins at such houses, and were instructed to have the occupiers' jugs left outside the doors, and the milk poured into the jugs without bringing the cans into contact with them. Slaughter Houses. The Slaughter Houses have been inspected at intervals and found to be kept in accordance with the bye-laws. There are only six of these premises in the District, and none of them are much used. Bakehouses. The Bakehouses, 22 in number, were examined during the year. A bakehouse in Hartfield Road, which is under 16 ground, became flooded with sewage, and as there were no means of effectively draining it a notice was sent requiring the occupier to discontinue its use. This he refused to do, and Police Court proceedings were taken. An undertaking was given by the occupier to do certain work required by the Council, they (the Council) undertaking to put in a new sewer. The work was not in hand at the end of the year. Sanitary Improvements Among the works in hand and carried out that affect the Sanitary conditions of the District the following may be mentioned:— Summerstown Drainage. The drainage of the Sumtherstown portion of the District has been completed, several houses being connected therewith. The new main sewer is taken under the River Wandle and discharges into an ejector station on the Sewage Farm. Flood Prevention Works. Sanction to a loan of £10,100 for the construction of a 3-ft. diameter sewer, with branches to relieve the flooding on the North side of the L. & S.W. Railway and Hartfield Road, has been obtained. The water conveyed by this sewer will be treated on the storm water filters at the Sewage Farm. Private Roads. The following roads have been made up during the year and declared "Highways rapairable by the inhabitants at large." Avenue Road. Bridges Road. Broadway Mews. Garfield Road. Newton Road. Prince's Road. Trevor Road. William Road. Contracts were entered into for making up the following roads, which have not yet been completed. Avondale Road. Cromwell Road. 17 Delamere Road. Ethelbert Road. Effra Road. Florence Road. Haydon Park Road. Lower Downs Road. Queen's Road. Southdown Road. Trinity Road. Wimbledon Park Road. York Road. House Drainage. The drains of 142 houses and premises havo been entirely re-constructed, and laid to stand the water test, with manholes for inspection purposes, and all up-to-date improvements. The following blocks of houses have been re-drained, the main drains were put in, in most cases, by the District Council, at their own cost:— Nos. 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, Berckley Road. „ 81, 83, 85, 87, De Burgh Road. „ 52, 54, 56, 58, Dundonald Road. „ 1, 2, 3, 4, 5, 6, 7,8, 9, 10} 11,12,13,14,15,16, }Elmore Terrace. „ 4, 6, 8, 10, Hubert Road. „ 90, 92, 94, 96, 98, Merton Road. „ 32, 34, 36, Norman Road. „ 15, 16, 17. South Place. „ 12, 12a, 13, 14, 15, 16, Thornton Road. „ 1, 2, 3, 4, Bank Buildings, Wandle Road. Besides these, several pairs of houses have been redrained, and many single ones. The large block of 48 tenements, known as Beehive Buildings, has been examined and thoroughly inspected, and 18 was found to be in a very unwholesome and insanitary condition. The owner has been communicated with and steps are being taken to have the whole block re-drained and rendered habitable. Nnisances. The nuisances dealt with arc summarized in Table I. Scavenging. The removal of house refuse is carried out by the District Council with their own carts. The removal takes place weekly and is under the direction of the Surveyor's Department. There has been no cause for complaint in the way this work has been carried out during the year. I cannot conclude this report without expressing my regret at the resignation of the Sanitary Inspector, Mr. Mayne, who has so ably assisted me in the discharge of my duties for the past eight years. I have the honour to be, Your obedient servant, E. POCKLINGTON, M.O.H. TABLE 1. The following is a Summary of the Nuisances complained of and inspected during the year, and the work carried out under the supervision of Mr. Mayne, the Sanitary Inspector:— Animals Removed 42 Ashpits Provided 83 Accumulations Removed 79 Bakehouses Cleansed 1 Cisterns Provided 8 Cisterns Cleansed 15 Cisterns Repaired 49 Corpses Removed 5 Drains, New Provided 142 Drains, Repaired and Altered 17 Flushing Boxes, New Provided 217 Flushing Boxes Repaired 20 Guttering and Spouting Provided 19 Guttering and Spouting Repaired 61 Houses Disinfected 155 Houses Cleansed and Whitewashed 34 Houses, Sites Concreted 24 Houses, Water laid on 4 Manure Pits Provided 2 Overcrowding Nuisances Abated 9 R. W. Pipes Provided, Disconnected, and Repaired 196 Roofs Leaky, Repaired 44 Smoke Nuisances Abated 3 Soil Pipes, New Provided 70 Urinals, Water laid on, Cleansed, etc. 3 Ventilating Pipes, New, Provided 184 Ventilating Pipes Repaired 7 Waste Pipes, Disconnected, Trapped and Repaired 195 Water Closets, Container Pattern, Removed 6 Water Closets, Repaired and Ventilated 5 Water Closets, New Provided 225 Yards Cleansed 13 Yards Paved 68 Total 1995 Tj^BLJE 2. Table shewing the number of Infectious Cases notified during each month of the year 1897, And the Totals during 1895-96. Diseases. January February March April May June July August September October November December Total 1897 Total 1896 Total 1895 Scarlet Fever under 5 4 5 3 1 4 ... 2 2 3 4 2 ... 155 124 76 5upw'ds 10 18 6 6 7 ... 8 6 8 24 27 5 Diphtheria under 5 2 1 1 ... ... 1 2 ... 1 ... ... ... 41 30 37 5upw'ds 2 3 ... ... 5 1 2 3 3 5 2 7 Typhoid Fever under 5 ... ... 1 ... 1 ... ... ... 1 ... 1 1 17 10 14 5upw'ds 1 2 1 ... 2 ... 1 ... 2 ... 3 ... Puerperal Fever under 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 5 1 5upw'ds ... ... 1 ... 1 1 1 ... 1 ... ... ... Membranous Croup under 5 ... ... ... ... ... ... ... ... 1 ... ... ... 2 0 2 5upw'ds ... ... ... ... ... ... ... ... ... ... ... 1 Erysipelas under 5 ... ... ... ... ... 1 2 ... 1 1 2 ... 44 35 35 5upw'ds 2 2 2 5 ... 4 2 1 3 5 3 8 Totals under 5 6 6 5 1 5 2 6 2 7 5 5 1 51 5upw'ds 15 25 10 11 15 6 14 10 17 34 35 21 213 21 31 15 12 20 8 20 12 24 39 40 22 264 TABLE 3. Table of Deaths during the Year 1897, in the Urban Sanitary District of Wimbledon, classified according to Diseases, Ages, and Localities. LOCALITIES. Mortality from all causes at subjoined ages. Mortality from subjoined causes, distinguishing deaths of children under 5 years of age. At all Ages. Und'r 1 year. 1 and und'r 5 5 and und'r 15 15 and und'r 25 25 and und'r 65 65 and wants 1 2 3 4 6 6 7 8 9 10 11 12 13 14 16 16 Public Institutions being shown as separate localities Small-pox. Scarlatina. Diphtheria. Enteric or Typhoid Fever. Puerperal Fever. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. (a) (b) (c) (d) (e) (f) (g) (h) WIMBLEDON 361 98 46 11 13 114 97 Under 5 ... 1 1 ... ... 1 14 7 27 ... 19 ... 1 6 67 144 5 upwards ... ... 5 1 1 1 2 ... 2 17 22 26 3 10 127 217 ATKINSON MORLEY'S HOSPITAL 2 ... ... ... ... 2 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 COTTAGE HOSPITAL . 3 ... 1 ... ... 2 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 DURNSFORD ROAD HOSPITAL 1 ... 1 ... ... ... ... Under 5 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TOTALS 367 98 48 11 13 118 97 Under 5 ... 2 1 ... ... 1 14 7 27 . . . 19 ... 1 7 67 146 5 upwards ... ... 5 1 1 1 2 ... 2 17 22 27 3 11 129 221 The subjoined numbers also been taken into account in judging of the above records of mortality Deaths occurring outside the district among persons belonging thereto. 33 1 2 1 10 19 Under 5 5 upwards 1 3 5 1 23 33 Deaths occurring within the district among persons not belonging thereto. 2 2 Under 5 5 upwards 1 1 2 Table of Population, Births, and of New Cases of Infectious Sickness coining to the knowledge of the Medical Officer of Health during the year 1897, in the Urban Sanitary District of Wimbledon classified according to Diseases, Ages, and Localities. Names of Localities. (a) Population at all ages. Registered Births. Aged under 5 or over 5. (e) New cases of sickness coming to the knowledge of the Medical Officer of Health. Number of such cases removed to Hospital. 1 2 3 4 5 6 1 Census, 1891. (b) Estimatd to Middle of 1897. (c) Scarlatina. Diphtheria. Enteric or Typhoid Fever. Puerperal Fever. Erysipelas. Membranous Croup. Scarlatina. WIMBLEDON (H.) 25,761 35,000 828 under 5 30 8 5 6 1 15 5 upw'ds 124 30 11 5 35 1 79 ATKINSON MORLEY'S HOSPITAL Yearly average Number of Patients 961. under 5 ... ... ... ... ... ... ... 6 upw'ds 1 3 ... ... 2 ... ... COTTAGE HOSPITAL Number of Patients 103 under 5 ... ... ... ... ... .. ... 5 upwds ... ... 1 ... ... ... ... DURNSFORD ROAD HOSPITAL Number of Patients 96 under 5 ... ... ... ... 1 ... ... 5 upw'ds ... ... ... ... ... ... ... TOTALS 25,761 35,000 828 under 5 30 8 5 ... 7 1 15 5 upw'ds 125 33 12 5 37 1 79 The Infectious Diseases Notification Act has been compulsory in the District since 1889. The Isolation Hospital for the treatment of patients is an iron building situated in Durnsford Road, and is capable of accommodating 16 Scarlet Fever Patients. NOTES ON TABLES 3 AND 4. 1. Medical Officers of Heallh of "Combined Districts" must make a separate It el urn fr the District if each District Council. 2. Medical Officers of Health tiding fur a portion only of the District of a District Council should write, in the heading of the Table, the designation of the Division for which they act. 3. The words "Urban" "Rural," or "Metropolitan" must be inserted in the appropriate space in the heading, according as the District is Urban or Rural, or is within the Metropolitan Area. 4. The "Localities" adopted for the purpose of these statistics should be areas of known population; such as parishes, groups of parishes, townships, or wards. As stated at the head of the first column in each Table, Public Institutions should be regarded as separate localities, and the deaths in them should be separately recorded. Workhouses, Hospitals, Infirmaries, Asylums, and other establishments into which numbers of people, and especially of sick people are received, are Public Institutions for the purpose of these statistics. 5. The deaths which have been classified in table (3), and summed up in the horizontal line of "Totals, "are the whole of those registered as having actually occurred in the several localities comprised within the Division or District. But the registered number of deaths frequently requires correction before it can give an exact view of the mortality of a Division or District; and the two lowest horizontal lines are provided for the purpose of enabling Medical Officers of Health to indicate, to the best of their ability, what the extent of such corrections should be. Details concerning the corrective figures, e.g., the institutions that have been considered, or the particular localities to which corrections apply, may appear in the text of the leport or in supplementary tables. Area and Population of the District or Division to which this Return relates. Area in Acres 3,220 Population (last Census) 25,761 „ (Estimated to the middle of 1897) 35,000 DEATH RATES. { por 1000 PopuGeneral 11.3 {la.ion estimated {to middle of {1897. Infant (under one} 118 {per 1000 Births year of age} { Registered. In recording the facts under the various headings of Tables 3 and 4, attention has been given to the notes endorsed on the Tables. SUMMARY OF TABLE 6. No. of Deaths. No. of Deaths. I.—SPECIFIC FEBRILE or ZYMOTIC DISEASES 37 Brought forward 325 2. Diarrhœal 29 IV.—LOCAL DISEASES—continued 3. Septic 4 6. Diseases of Re-productive System— (a) Organs of Generation 3 II. CONSTITUTIONAL DISEASES 65 (b) Accidents of Parturition 2 7. Diseases of Integumentary System 1 III. DEVELOPMENTAL DISEASES 33 V.—VIOLENCE. IV.—LOCAL DISEASES. 1. Accident 13 1. Diseases of Nervous System 33 2. Suicide 5 2. Diseases of Circulatory System 33 3. Diseases of Respiratory System 45 VI-ILL-DEFINED AND NOT SPECIFIED CAUSES 18 4. Diseases of Digestive System 33 5. Diseases of Urinary System 13 Carried forward 325 Total 367 TABLE 5. Distribution and Particulars of Infectious Cases Notified. Diseases. Alexandra Road. Amity Grove. Atkinson Morley's Hospital. Beehive Buildings. Broadway. Cambridge Road. Caroline Road. Church Road. Cecil Road. Clarence Road. Cochrane Road. Common. Copper Mill Lane. Cottage Hospital. Courthope Villas. Cowper Road. Cromwell Road. Crooked Billett. Dairy Walk. Deburgh Road. Denmark Avenue. Denmark Road. Derby Road. Dryden Road. Dundonald Road. Durnsford Hospital. Durnsford Road. East Road. Edge Hill. Ethelbert Road. Florence Road. Gap Road. Gladstone Road. Goodenough Road. Grange (The). Granville Road. Griffiths Road. Hamilton Road. Harcourt Road. Hardy Road. Hartfield Crescent. Hartfield Road. Haydon Park Road. Haydon Road. Herbert Road. High Street, Wimbledon. High Street, Merton. Hill Road. Homefield Road. Diphtheria under 5 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 5 upwards ... ... 3 1 ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 2 ... Membranous Croup under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 5 upwards 1 1 2 ... 2 ... ... ... 1 ... 1 ... 1 ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... 1 ... 2 ... 2 ... 1 ... ... ... ... ... Scarlet Fever under 5 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 2 ... ... 2 1 ... 1 ... ... ... 5 upwards ... 3 1 ... ... 1 1 1 3 ... 1 4 ... ... 1 ... ... 1 1 2 1 6 ... ... 1 ... ... 1 2 1 1 ... 2 1 2 1 1 1 1 9 2 1 ... 7 1 2 ... ... 1 Enteric or Typhoid under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... Puerperal Fever under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Totals under 5 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 1 ... ... ... ... ... 6 ... 2 2 1 ... 2 ... ... ... 5 upwards 1 4 6 1 2 1 1 1 4 3 2 4 1 1 1 1 ... 2 1 3 1 7 1 1 1 ... 1 1 2 1 2 1 5 2 2 1 2 2 1 11 3 3 1 11 1 2 1 2 1 TABLE 5—Continued. Diseases. Hubert Road. King's Road. Kingston Road. Kingswood Road. Lancaster Road. Latimer Road. Lauriston Road. Merton Road. Merton Hall Road. Milton Road. Nelson Road. Norman Road. North Road. Palmerston Grove. Palmerston Road. Pelliam Road. Prince's Road. Queen's Road. Ridgway. Ridgway Place. Ridley Road. Riverside Road. Russell Road. Somerset Road. South Place. South Road. Southdown Road. South Park Road. Springfield Road. Stanley Road. St. George's Road. St. John's Road. Thornton Road. Trafalgar Road. Trevor Road. Victory Road. Vineyard Hill. Wandle Bank. Wandle Road. Wilton Road. Wimbledon Hill. Woodside. Worple Road. Wyclitfe Road. Total. Diphtheria under 5 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... ... 8 41 5 upwards ... ... 1 ... ... 1 ... 2 ... ... 2 1 ... ... ... ... ... ... ... 1 1 1 1 ... ... ... 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 33 Membranous Croup under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 7 44 5 upwards ... 1 ... ... ... ... ... 2 ... ... ... 1 ... ... 2 ... 1 1 1 ... 1 ... 1 ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 37 Scarlet Fever under 5 ... ... 2 ... ... ... ... ... ... ... ... 2 ... ... 1 3 ... ... ... ... ... ... 1 ... ... 1 ... 4 ... ... ... ... ... ... 1 3 ... 1 ... ... ... ... ... ... 30 155 5 Upwards ... 1 1 ... 1 ... 1 ... 2 ... 1 1 2 4 1 4 ... ... 1 ... ... ... 3 2 3 5 3 4 1 ... 1 ... 4 1 ... 0 ... 1 2 ... 1 1 2 ... 125 Enteric or Typhoid under 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 5 17 5 upwards ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 5 upwards 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Totals under 5 ... ... 2 ... ... ... ... 1 ... ... ... 2 1 ... 2 3 ... ... ... 1 ... ... 2 ... ... 2 ... 6 ... ... ... ... ... 1 1 3 ... 1 1 ... ... ... ... 1 51 264 5 upwards 1 2 2 1 1 1 1 5 2 1 4 3 2 4 3 5 1 1 2 1 2 1 6 2 3 6 6 5 1 1 1 1 4 1 ... 8 1 1 3 1 1 2 3 ... 213 TABLE 6. WIMBLEDON URBAN SANITARY AUTHORITY. Table showing Deaths from all causes and at different ages. Cause of Death. A G E S. 2. 3. 4. 5 6. 7. 8. 9. 10. 11. 12. 13. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and up wards Total. Classes. I.—Specific Febrile, or Zymotic Diseases 33 21 6 1 1 ... 3 2 1 2 ... 70 II.—Constitutional Diseases 2 4 1 5 9 6 11 15 5 7 ... 65 III. Developmental Diseases 13 ... ... ... ... ... ... ... 4 12 4 33 IV.—Local Diseases 34 19 2 4 11 14 15 24 24 14 2 163 V.—Deaths from Violence 4 3 2 3 2 3 ... 1 ... ... ... 18 VI.—Deaths from Ill-Defined and Not Specified Causes 12 1 ... ... ... ... ... 1 1 3 ... 18 Totals 98 48 11 13 23 23 29 43 35 38 6 367 I.-Specific Febrile,or Zymotic Diseases l. —M iasmatic Diseases. Measles 1 13 2 ... ... ... ... ... ... ... ... 16 Scarlet Fever 1 1 ... ... ... ... ... ... ... ... ... 2 Whooping Cough 5 2 ... ... ... ... ... ... ... ... ... 7 Diphtheria ... 1 4 ... ... ... 1 ... ... ... ... 6 Enteric or Typhoid Fever ... ... ... ... ... ... ... 1 ... ... ... 1 Membranous Croup ... 1 ... ... ... ... ... ... ... ... ... 1 Influenza 1 ... ... ... ... ... 1 ... 1 1 ... 4 2.—Diarrhceal Diseases Diarrhoea 24 3 ... ... ... ... 1 1 ... ... ... 29 3.—Septic Diseases. Erysipelas 1 ... ... ... ... ... ... ... ... 1 ... 2 Septicaemia ... ... ... 1 ... ... ... ... ... ... ... 1 Puerperal Fever ... ... ... ... 1 ... ... ... ... ... ... 1 II.—Constitutional Diseases. Rheumatic Fever ... ... ... 2 ... ... ... ... ... ... ... 2 Rheumatism ... ... ... ... 1 ... ... ... ... ... ... 1 Gout ... ... ... ... ... ... ... ... ... 1 ... 1 Cancer ... ... ... ... ... 3 6 13 5 5 ... 32 Tabes Mesenterica 1 ... ... ... ... ... ... ... ... ... ... 1 Tubercular Meningitis 1 2 ... ... ... ... ... ... ... ... ... 3 Phthisis ... ... 1 2 7 1 4 1 ... 1 ... 17 Other forms of Tuberculosis ... 2 ... ... 1 1 ... ... ... ... ... 4 Anaemia ... ... ... 1 ... ... ... ... ... ... ... 1 Diabetes Mellitus ... ... ... ... ... 1 1 ... ... ... ... 2 Asthenia ... ... ... ... ... ... ... 1 ... ... ... 1 III —Developmental Diseases. Premature Birth 7 ... ... ... ... ... ... ... ... ... ... 7 Atelectasis 2 ... ... ... ... ... ... ... ... ... ... 2 Old Age ... ... ... ... ... ... ... ... 4 11 4 19 Aortic Stenosis ... ... ... ... ... ... ... ... ... 1 ... 1 Marasmus 4 ... ... ... ... ... ... ... ... ... ... 4 IV.—Local Diseases. 1- Diseases of Nervous System. Inflammation of Brain or Membranes 7 1 ... ... ... ... ... ... ... ... ... 8 Apoplexy, Softening of Brain ... ... ... ... ... ... ... 1 6 4 ... 11 Epilepsy ... ... ... 1 1 ... ... ... ... ... ... 3 Convulsions 9 ... 1 ... ... ... ... ... ... ... ... 10 Paralysis Agitans ... ... ... ... ... ... 1 ... ... ... ... 1 2. — Diseases of Circulatory System. Valvular Diseases of Heart ... ... ... 1 ... 2 ... 2 1 ... 1 7 Other Diseases of Heart ... ... 1 1 1 1 4 5 4 2 ... 19 Fatty Degeneration of the Heart ... ... ... ... ... ... ... ... ... 1 ... 1 Embolism ... ... ... ... 1 ... ... ... ... ... ... 1 Other Diseases of Blood Vessels 1 ... ... ... ... ... ... ... ... ... ... 1 Syncope ... ... ... ... ... ... 3 1 ... ... ... 4 3. — Diseases of Respiratory System. Laryngitis ... 2 ... ... ... 1 ... ... ... ... ... 3 Asthma ... ... ... ... ... ... ... 1 ... ... ... 1 Bronchitis 5 3 ... ... ... ... ... 3 7 2 ... 20 Pneumonia 3 8 ... ... 2 2 1 1 2 2 ... 21 4. — Diseases of Digestive System. Dentition 1 4 ... ... ... ... ... ... ... ... ... 5 Inflammation of Stomach ... ... ... ... ... ... ... 1 ... ... 1 2 Enteritis 8 1 ... ... ... ... ... ... ... ... ... 9 Obstructive Diseases of Intestine ... ... ... ... 1 ... ... 2 ... 2 ... 5 Gastric Ulcer ... ... ... 1 ... ... ... ... ... ... ... 1 Peritonitis ... ... ... ... 1 2 2 ... ... ... ... 5 Ascites ... ... ... ... ... 1 ... ... ... ... ... 1 Cirrhosis of Liver ... ... ... ... 1 ... ... 1 2 ... ... 4 Typhlitis ... ... ... ... 1 ... ... ... ... ... ... 1 5.—Diseases of Urinary System. Nephritis ... ... ... ... 1 1 2 4 1 1 ... 10 Stone in Bladder ... ... ... ... ... 1 ... ... ... ... ... 1 Cystitis ... ... ... ... ... ... ... 1 ... ... ... 1 Uraemia ... ... ... ... ... 1 ... ... ... ... ... 1 6.—Diseases of Reproductive System. a. Organs of Generation Female Organs Sarcoma of Uterus ... ... ... ... ... ... 1 1 ... ... ... 2 Fibrous Tumor of Uterus ... ... ... ... ... ... 1 ... ... ... ... 1 b. Accidents of Parturition. Placenta praevia, Flooding ... ... ... ... 1 1 ... ... ... ... ... 2 7.—Diseases of Integumentary System. Carbuncle ... ... ... ... ... ... ... ... 1 ... ... 1 V.—Deaths from Violence. 1.—Accident or Negligence. Concussion of Brain ... ... 1 1 ... ... ... ... ... ... ... 2 Fractures and Contusions ... 1 1 ... 1 ... ... 1 ... ... ... 4 Burn, Scald ... 2 ... ... ... ... ... ... ... ... ... 2 Suffocation 4 ... ... ... ... ... ... ... ... ... ... 4 Lightning ... ... ... 1 ... ... ... ... ... ... ... 1 2.—Suicide. ... ... ... ... ... ... ... ... ... ... ... ... Poison ... ... ... 1 ... 1 ... ... ... ... ... 2 Drowning ... ... ... ... ... 1 ... ... ... ... ... 1 Hanging ... ... ... ... ... 1 ... ... ... ... ... 1 Otherwise ... ... ... ... 1 ... ... ... ... ... ... 1 VI.—Deaths from Ill-Defined and Not Specified Causes. Debility, Atrophy, Inanition 11 1 ... ... ... ... ... ... ... 2 ... 14 Haemorrhage ... ... ... ... ... ... ... 1 1 1 ... 3 Causes not specified or Ill-Defined 1 ... ... ... ... ... ... ... ... ... ... 1