URBAN SANITARY DISTRICT OB1 WIMBLEDON, COUNTY OF SURREY. Report of the Medical Officer of Health For the Year ending December 31st, 1898. Wimbledon Urban District Council. SANITARY DEPARTMENT. Report of the Medical Officer of Health FOR THE YEAR ENDED 31st DECEMBER, 1898. Gentlemen, I have the honour to present my Annual Report for the year ended the 31st December, 1898. The total number of births registered was 963 (472 males, 491 females), which is 135 more than last year, equal to a birthrate of 25 3 per thousand per annum, which is 165 higher than last year. The birth-rate in England and Wales, for the same period, is given at 29 4 in the report of the Registrar General. The total number of deaths registered was 415 (199 males, 216 females), equal to a death-rate of 10.9 per thousand living per annum; taking the population at 38,000 (the estimated population at Midsummer, 1898.) 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 442, and the death-rate 116. The death-rate Births. Deaths. 2 for England and Wales for the same period is given as 17.6. The deaths which occurred outside the district among persons belonging thereto which have come to my knowledge were 4 at Brookwood Asylum, and 28 at Kingston Infirmary. The deaths which occurred within the district among persons not belonging thereto which have come to my knowledge were 5 in Atkinson Morley's Hospital. Infant mortality is represented by a ratio of 150 deaths under one year of age to 1,000 registered births, as against 161 deaths per 1,000 births in England and Wales for the same period. This rate varies very much with the diarrhœal mortality. Between the ages of 1 and 60 there were 151 deaths, and 119 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 2 deaths, against 4 last year, 4 in 1896, 14 in 1895, 10 in 1894, and 20 in 1893. There were 14 deaths from bronchitis, 38 from pneumonia and 20 from phthisis, (see Table 6, in which is classified the whole of the deaths as to their causes and ages). In column I will be seen the chief causes of mortality among the 145 infants who died during the year. Comparing the deaths from Respiratory diseases with those that occurred last year, a slight increase is noted. The number of deaths from Zymotic diseases (including Influenza) was 76, viz.: from Measles 2; Scarlet Fever 2; Diphtheria 7; Diarrhoea 56; Whooping Cough 3; Enteric Fever 1 ; Erysipelas 3 ; Influenza 2. 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. 1898 1897 1896 1895 1894 Births 963 828 875 857 794 Deaths 415 367 343 377 310 Death-rates 11.6 11.3 11.06 12.1 10.3 DEATHS— Under 1 year 145 98 97 102 81 Over 1 year and under 60 years 151 175 150 174 147 Above 60 years 119 94 96 101 82 From Measles 2 16 9 2 6 ,, Scarlet Fever 2 2 2 0 0 ,, Small Pox 0 0 1 0 0 ,, Diphtheria 7 6 3 16 10 „ Diarrhœa 56 29 13 15 6 ,, Whooping Cough 3 7 15 23 8 ,, Enteric Fever 1 1 3 1 3 ,, Puerperal Fever 0 1 2 1 0 ,, Erysipelas 3 2 0 1 1 ,, Influenza 2 4 4 14 10 ,, Membranous Croup 0 1 0 2 0 4 TABLE B. DISEASES. 1898. 1897. 1896. 1895. 1894. Cases Notified Deaths Cases Notified Deaths Cases Notified Deaths Cases Notified Deaths Cases Notified Deaths Small Pox 0 0 0 0 2 1 1 0 1 0 Puerperal Fever 3 0 5 1 5 2 1 1 0 0 Diphtheria 60 7 41 6 30 3 37 16 43 10 Membranous Croup 0 0 2 1 0 0 2 2 1 0 Scarlet Fever 98 2 155 2 124 2 76 0 93 0 Enteric Fever 11 1 17 1 10 3 14 1 13 3 Erysipelas 58 3 44 2 35 0 33 1 45 1 Measles 55 2 0 16 0 9 0 2 0 6 Totals 285 15 264 29 206 20 164 23 196 20 TABLE C. Zymotic Rate. 1898 1897 1896 1895 1894 1893 1892 1891 1890 1889 2.0 2.0 1.63 2.03 1.50 2.03 1.7 1.15 0.62 1.18 Scarlet Fever. Scarlet Fever of a mild type has been present during the whole year, 98 cases having been notified against 155 last year, a satisfactory decline of 57, and this with an increased estimated population of 3,000. Of these cases 61 were treated at the Infectious Diseases Hospital, the remainder at their homes. In several instances the cases were imported from other districts, one case in point, being that of a young man visiting Wimbledon friends on the Sunday, feeling unwell, sought medical advice, was found to be suffering from Scarlet Fever, notified as such and removed to the Isolation Hospital. 5 The proportion amongst adults is again very small giving further confirmation to the statement that Scarlet Fever is not a disease of adult life, and every additional year to a child's life diminishing its probability of falling a victim, this should encourage all to persevere in their efforts to check the spread of the disease by isolation and other means. In September and October an increase in the number of patients whose removal was necessary occured, making the number of patients in the hospital very near the maximum accommodation provided. One of the hospital tents was prepared for use if necessary, but a decrease taking place, happily the provision was not needed. In several instances desquamation had commenced before medical aid was procured. In all cases of infectious disease of children attending school the Head Master or Mistress is notified, and all children from the same house prohibited from attendance until some time after the rooms, clothing, etc., has been disinfected. Sixty cases were notified during the year, and seven deaths registered, against forty-one last year, and six deaths. Several of the cases were imported from other districts, and four cases were notified from 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 to 5 years, nineteen cases and four deaths; 5 to 15 years, thirty-one cases and three deaths; 15 to 25 years, four cases no deaths; 25 to 35 years, four cases no deaths; 35 to 45 years, two cases no deaths. The great increase of Diphtheria in its prevalence and fatality is a matter of serious importance. An increase has taken place in the Metropolis and Suburbs generally, but not quite to the same extent as in Wimbledon. Undoubtedly the absence of hospital Diphtheria. 6 accommodation partly accounts for this increase as it necessitates the patients being kept at home, where in most cases the means of isolation is of the poorest, thus in many instances the case becomes a centre of infection. Of this year's cases, seventeen occurred in six houses as follows :—in one house five cases, another four, and at four other houses two cases each It is highly important that Diphtheria patients should be promptly isolated. I trust the building of the New Isolation Hospital will be pushed on with all speed, the advantages of an Infectious Hospital are great, not only on account of the difficulties existing in the way of isolation in private houses, but also because the serum treatment is there more readily resorted to than is possible in private practice. That this treatment of Diphtheria is most valuable in reducing the mortality has now passed beyond the region of doubt, as may be seen by referring to the reports on this subject by the Hospital Superintendents of the Metropolitan Asylums Board, an extract of which is given below. The report of the Medical Superintendents upon the us of the Antitoxin Serum in the treatment of Diphtheria in the Hospitals of the Metropolitan Asylurnns Board during the yeai 1896, draws the conclusion that the improved results in the Diphtheria cases treated during the year are due to.— (i.) A great reduction in the mortality of cases brought under treatment on the first three days of illness. (ii.) The lowering of the combined general mortality to a point below that of any former year. (iii.) The still more remarkable reduction in the mortality of the laryngeal cases. 7 (iv.) The uniform improvement in the result of tracheotomy at each separate hospital. (v.) The beneficial effect produced on the clinical course of the disease. Great stress is laid upon the paramount importance of commencing the treatment early—if possible, not later than the second day of the disease. The opinion is again expressed that antitoxin serum is a remedy of much greater value in the treatment of Diphtheria than any other known. In several instances I have obtained admittance of Diphtheria patients into London Hospitals for treatment, which kindness from the hospital authorities was much appreciated. The Council's ambulance and attendants being lent for the purpose of conveyance to London. In only a few cases so far as I can ascertain has a bacteriological examination been made. In the future I hope more use may be made of the means provided by the Council for verification of diagnosis in doubtful cases. This is an important matter, inasmuch that infectious cases are liable to be overlooked, and become unsuspected centres of infection : on the other hand some are notified which may be nothing of the kind, thus causing needless expense and anxiety, an instance of the latter recently came under my notice: an outpatient attending a general hospital was notified as suffering from Diphtheria, he was able to take his food well, and being surprised at the notification, consulted another medical man the following morning, who failed to find any trace of Diphtheria. The patient, a labourer, continued at his usual work. It is much to be regretted that in some cases parents and others having charge of children suffering from this disease 8 are not as careful as they might be in the matter of isolation, evidently not realizing the danger of others visiting the house. It is difficult to combat this dangerous disease, so little being known of its actual cause, but ^doubtless sewer gas, bad drains, wet sites, and dampness generally are predisposing causes. In eighteen houses where the disease occurred the drains and sanitary arrangements were in a very defective condition, and at four of these houses the cases were fatal. Of the sixty cases notified twenty-seven attended schools, viz.: nine Holy Trinity Schools; seven Haydon's Road Schools; five Dundonald Schools; two the Roman Catholic Schools, and four private schools. Eleven cases were notified, and one death occurred against seventeen last year and one death, and ten in 1896 and two deaths. No cases occurred in February, March, April, June, July and August. Two cases occurred in January, two in May, one in September, two in October, two in November, and two in December, (see Table 2). The fatal case occurred in May at a house in Nelson Road, a boy, aged 5 years. Two of the cases were attributed to eating shell fish. Two were builder's foremen whose work naturally laid them open to danger, two others contracted the disease in London, and the fatal case occurred where the drains and manhole were choked. At those premises where defects were found, they were remedied, and particular attention given to the cleansing of the drinking water cisterns. In the remaining cases the cause could not be traced. Since the commencement of the year the Head Masters and Mistresses of the Public Elementary Schools have kindly furnished me with a list of absentees, the cause of whose Typhoid Fever. Measles. 9 absence was suspected to be measles, in all, about 130 of these were received and doubtless were of much assistance in checking the spread of the disease. An outbreak occurred amongst the children attending the Cottenham Park Schools in June. On June 1st, out of a total of about 200 scholars only 60 were present. I considered it desirable to have the schools closed for a period and disinfected; which was done; the school remaining closed for one month. The Local Government Board sanctioned the inclusion of Measles in the list of notifiable infectious diseases for a limited period, which extension came into force on June 27th last. It is gratifying to record only two deaths from Measles during last year, against 16 in 1897, and 9 in 1896. In 1897, Measles was responsible for more deaths than all other infectious diseases, viz. : Measles 16; all others 15. In previous Annual Reports I have strongly urged the compulsory notification of Measles, and this year's experience shows its value. Forty-eight cases of Erysipelas were notified, and three deaths (all under 5 years of age), were attributed to this disease. It is hard to see what advantage results from the requirement of notification of these cases. I think Erysipelas might well be struck off the list of notifiable disease. The deaths from Diarrhoea numbered fifty-six. The age incidence of the fatal cases was as follows: 0—1 year, fifty; 1—5 years, six. This number does not include nine deaths from Enteritis (which is a diarrhœal disease), five of which were of children under one year of age. The number of deaths from Diarrhoea is higher than has been the case for some years, and constitutes 73 per ccnt. of the deaths from Zymotic diseases, apart from the deaths from Erysipelas. Diarrhœa. 10 this cause the Zymotic death-rate instead of being 2.0, would only have been -52. The importance of this disease cannot be overestimated, its prevalence is associated with certain climatic conditions beyond our control, such as a high temperature and a dry season, there are however other equally well determined factors over which we may exercise control more or less, the most important of which are— (i.) The density of population or overcrowding. (ii.) Domestic darkness and general dirtiness of dwellings (these conditions are only to a small extent under the influence of the Sanitary Authority). During the year 102 houses have been cleansed and limewashed, this however is of little avail unless some effort is made on the part of tenants themselves as regards cleanliness, etc. (iii.) Filthy accumulation of domestic refuse in dilapidated brick ashpits, boxes, etc.—this cause is especially liable to produce foul emanations in the hot summer months, the smells caused by animal and vegetable refuse are greater and create more nuisance than at other times, for the simple reason that decomposition takes place more quickly in hot weather. I should like if possible a bi-weekly collection of refuse during the summer months. (iv.) A still more common cause of this complaint is the badly arranged artifical feeding of infants; the mortality amongst hand-fed chddren being much heavier than amongst breast-fed. Much good might be done in this direction by district visitors and other lady workers in the poorer neighbourhoods, by using their influence in 11 inculcating rational notions on the best method of feeding infants, and in general cleanliness. I am certain that a prompt and complete removal if possible, of all organic refuse, the paving of yards, and all open spaces immediately around dwellings with an impervious paving, and the sealing of the ground upon which the house stands against the access of contamination from the soil, by a bed of good concrete, (as is done in all new houses now) must in the future have a considerable influence for the better in checking this disease. The essential condition to an epidemic of "summer diarrhoea "was present in a high temperature during August and September. The rainfall in August was 1.04, and in September 1.22. Table A on page 3 shows at a glance the deaths from Diarrhoea for the past five years. The following table shows the temperature, rainfall, and number of deaths per fortnight from July 16th to October 8th. Mean Temperature for Fortnight. Number of Deaths in Fortnight. Rainfall in Fortnight in inches. Fortnight ending July 30 58 0 .78 „ „ Aug. 13 62 2 .72 ,, ,, ,,27 65 18 .17 „ ,, Sop. 10 67 22 .15 ,, ,, ,,24 62 13 .17 ,, ,, Oct. 8 59 0 .05 Whooping Whooping Cough caused three deaths, as against seven Cough in 1897, and fifteen in 1896. 12 Three cases were notified, and none proved fatal. In each case 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. 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, on the understanding that the Council's representation on the Joint Board shall consist of three elected representatives out of twelve, and one ex-officio representative out of three. A Local Government Inquiry was held at the Croydon Town Hall on the subject. There was no opposition, and a Provisional Order constituting the Joint Board was made and submitted to Parliament for confirmation. During the year 61 patients were admitted to the Hospital suffering from Scarlet Fever. Two cases proved fatal. The following Table shows the cases of Scarlet Fever admitted to the Hospital during each month of the year. Puerperal Fever. Small Pox. Infectious Diseases Hospital. Disease. Age. January. February. March. April. May. June. July. August. September. October. November. December. Total. Scarlet Fever Under 5 0 2 3 0 2 1 0 2 2 0 2 2 16 5 upwards 5 2 6 4 1 5 3 2 2 8 4 3 45 Total All ages 5 4 9 4 3 6 3 4 4 8 6 5 61 13 14 There is no provision at present for the treatment of any other diseases than Scarlet Fever, but there is now good prospect of having suitable Hospital accommodation within no distant period. Tenders for the erection of the New Hospital have been invited. 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. The following Table shows the number of articles disinfected in the hot air chamber after each disease. Diseases. Mattresses. Pallia see. Beds. Pillows and Bolsters. Blankets. Dresses. Suits. Other Articles. Totals. Scarlet Fever 50 14 172 306 240 41 26 1193 2048 Diphtheria 12 15 57 125 96 ... 17 297 619 Typhoid Fever 2 ... 5 16 8 ... ... 21 52 Measles 8 ... 17 42 41 1 2 89 200 Totals 78 29 251 489 385 42 45 1600 2919 Disinfection. 15 The disinfection of infected bedding and clothing is carried out by means of a hot air chamber. This arrangement is not a satisfactory one, as the penetrating power of hot dry air is not sufficient to destroy bacteria which may lodge in the folds of garments, or in the inside of mattresses, pillows, etc. It is impossible to raise the temperature of the oven enough to get sufficient heat in the inside of these articles for their thorough disinfection without scorching and injuring them externally. The only thorough way of disinfecting wearing apparel and bedding is by means of a steam apparatus, which is the method proposed to be provided at the new hospital buildings. Besides having the clothes thoroughly done, the saving in time is considerable. The hot air system takes at least four hours for one baking, while with the steam apparatus the work is done in 30 minutes. This is a great saving in time, and as it is important that poor people who have their bedding taken away should have it back as soon as possible, this advantage becomes apparent. The number of rooms disinfected was 212. Thirty library books were disinfected. It is certain that infectious disease may be spread through the medium of circulating libraries, and this is sometimes used as an argument against their establishment. Recently, in order to abolish as far as possible any risk of contagion from this source, an arrangement has been made whereby the Librarian receives from the Sanitary Department weekly, a list of houses where infectious disease has been notified; this will prevent the issue of books to such houses. If, however, books from the Library are known to be in a house where infectious disease is, they are taken possession of by the Sanitary Department and either disinfected before being returned to the library, or destroyed, as circumstances require. 16 I trust these precautions may be of service in preventing the spread of infectious disease, and also remove any objections which exist on this score in connection with the use of the Library. With a view to the appropriation of a part of the Upper Cemetery Field as a site for the new Hospital, steps were taken to appropriate a corresponding area from the Sewage Farm to Burial purposes, and on the 1st July, 1897, the Home Office approved of the last-mentioned land being added to the Cemetery in lie u of the Hospital site. The sanction of the Local Government Board to such transfer was given on the 23rd October, 1897. The Council gave the Local Government Board an undertaking not to treat smallpox cases on the Hospital site, or on any other site within a quarter of a mile of it. New Hospital. Land Securities Co. v. Council. The action brought by the Land Securities Co. to restrain the Council from proceeding with the scheme was discontinued, and the Council's costs were taxed and paid out of the amount deposited in Court by the nlantiffs as security. Water Supply. The recent outbreaks of Typhoid Fever in various parts of the country naturally causes anxious thought to sanitary authorities as to the purity of their water supply. The importance of this subject is such that the utmost vigilance is required to be directed to the source of the supply; freedom from water-borne typhoid in the past being no safeguard for the future. This district is supplied by the Lambeth and the Southwark and Vauxhall Companies, two of the companies supplying the Metropolis, whose source of supply is already carefully watched by the Local Government Board and the London County Council, as well as by the companies' own experts. The householders anxiety can therefore be limited to the care of the water after it is received from the company's main. If the supply be direct from the main there is little to 17 fear, but if through a storage cistern, steps should be taken to ascertain that the latter's position is such that it can easily be cleansed, is well covered to exclude dust, and foreign bodies, and free from possible contamination by being disconnected from direct communication from all water closets and drains. Animals a nuisance. The improper keeping of animals, such as pigs, horses, ducks, fowls, rabbits, etc., are a source of trouble. The costermonger class are the chief offenders in this respect: they run up temporary stalls of old boards in their back yards, and keep horses, without making any attempt at paving or draining the stables. Brick Ashpits. The nuisances arising from the large old-fashioned brick ashpits, which are often the receptacles for all sorts of animal and vegetable matter, must not be overlooked, as the odours which escape from decomposing organic matter are very dangerous, especially to children, who use the back yards as playgrounds. These ashpits are being gradually abolished and substituted by galvanized iron bins of small capacity, which necessitates more frequent removal of the rubbish; 191 have been provided during the year. Factory and Workshops Act. Several of the Workshops have been examined, some on complaint from Her Majesty's Inspector of Factories. At two Workshops, new w.c. accommodation was provided under notice from the Inspector, several notices to cleanse were complied with. Overcrowding Thirteen cases of overcrowding were abated without the id of legal proceedings, but the nuisances were only abated s far as the houses complained of were concerned. Dairies. The Dairies, Cowsheds and Milkshops have been inspected, and a new register made during the year. 18 Slaughter Houses. There are now 34 of these premises in the District, nine having been registered during the year. 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. The Bakehouses, 22 in number, were examined during the year. A bakehouse in Hartfield Road, which is under ground and liable to become flooded with sewage has been closed, and one new one opened. They were generally found clean and in good order. Among the works in hand and carried out that affect the Sanitary conditions of the. District the following may be mentioned :— Flood Prevention Works. 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 completed. 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 repairable by the inhabitants at large." Avondale Road. Haydon Park Road. Trinity Road (Sec. II.) Effra Road (Sec. I.) Lower Downs Road. Southdown Road (Sec. I.) Cromwell Road. Queen's Road (Sec. III.) Florence Road. York Road (Section I.) Delamere Road. Ethelbert Road (Sec. I.) Contracts were entered into for making up the following roads, which have not yet been completed. Bakehouses. Sanitary Improvement 19 Pepys Road (Sec. II.) Pepys Road (Sec. III.) Cambridge Road. Worple Road West. Ridgway Gardens. Edge Hill (Sec. II.) Effra Road (Sec. II.) Clarence Road. Ashley Road. Edith Road. Caxton Road. Olive Grove. Broadway Place. Hamilton Mews. House Drainage The drains of 186 houses and premises have been entirely re-constructed, and laid to stand the water test, with manholes, etc., for inspection and cleansing purposes. The following blocks of houses have been re-drained, the main drain in some cases being put in by the District Council at their own costs:— Beehive Buildings. 38, 40, 42,44, Wandle Road. 89, 91, 93, 95, Haydon's Road. 12, 13, 14, East Road. 72, 74, 76, 78, 80, 82, 84, Hubert Road. 2, 4, 6, 8, 10, 12, 14, 16, 18, Cross Road. 223, 225, 227, 229, Haydon's Road. 59, 61, 63, 67, Deburgh Road. 62, 64, 66, 68, South Road. 1, 2, 3, 4, 5, 6, 7, 8, Cowper Road. 1, 2, 3, Miller's Mead. 192, 194, 196, 198, 200, 202, 204, 206, 208, Haydon's Road. 1, 2, 3, 4, 5, 6, 7, 8, Thurstan Road. and several pairs of houses. The large block of 48 tenements, known as Beehive Buildings, has been inspected, and put in thoroughly good condition. 1 to 8, Thurston Road. Notices to re-drain these premises were served as long ago as January, 1896; delays from time to time having occurred owing to change of ownership, and legal and other quibbles. 20 However, I am pleased to see, that owing to the energetic action of the Sanitary Inspector, the owners have realised their duty and responsibility. The houses have been re-drained, the yards paved, rain-water pipes and guttering repaired, the roofs made watertight, and the houses generally put into thorough sanitary repair. Nuisances. The nuisances dealt with are 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. Mr. Mayne having resigned his appointment as Sanitary Inspector, Mr. Henry Johnson was, in March, appointed to fill the vacancy ; and during the time he has held office, I have found him a very active and efficient officer, thoroughly conversant with his duties, and a valuable acquisition to the staff. I have the honour to be, Your obedient servant, E. POCKLINGTON, Medical Officer of Health 21 TABLE 1. The following is a Summary of the work carried out in the abatement of Nuisances, under the supervision of Mr. Johnson, the Sanitary Inspector:— Animals Removed 17 Dustbins Provided 191 Ashpits Repaired 30 Accumulations Removed 168 Bakehouses Cleansed 12 Bakehouses Repaired 11 Cisterns Provided 18 Cisterns Cleansed 131 Cisterns Repaired 137 Cesspools Abolished 2 Drains, New Provided 186 Drains, Repaired and Altered 27 Flushing Boxes, New Provided 238 Flushing Boxes Repaired 54 Guttering and Spouting Provided 7 Guttering and Spouting Repaired 79 Houses Cleansed and Whitewashed 102 Houses, Sites Concreted 8 Houses, Water laid on 14 Manure Pits Provided 5 Overcrowding Nuisances Abated 13 R. W. Pipes Provided, Disconnected, and Repaired 221 Roofs Leaky, Repaired 73 Rooms Disinfected 212 Smoke Nuisances Abated 5 Soil Pipes, New Provided 83 Urinals, Water laid on, Cleansed, etc. 0 Ventilating Pipes, New, Provided 264 Ventilating Pipes Repaired 11 Waste Pipes, Disconnected, Trapped and Repaired 262 Water Closets, Container Pattern, Removed 5 Water Closets, Repaired and Ventilated 17 Water Closets, New Provided 273 Yards Cleansed 46 Yards Paved 92 Total 3014 TABLE 2. Table shewing the number of Infectious Cases notified during each month of the year 1893, And the Totals during 1895-96-97. Diseases. January February March April May June July August September October November December Total 1898 Total 1897 Total 1896 Total 1895 Membranous Croup under 5 ... ... ... ... ... ... ... ... ... ... ... ... 2 0 2 5upw'ds ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fevr under 5 1 2 5 2 2 1 2 2 2 ... 3 2 98 155 124 76 5upw'ds 9 4 9 6 4 8 4 4 6 10 5 5 Diphtheria under 5 2 1 1 ... 1 ... 2 2 4 ... 3 3 60 41 30 37 5upw'ds 7 2 1 ... 2 4 4 3 4 3 6 5 Typhoid Fever under 5 ... ... ... ... ... ... ... ... ... ... ... ... 11 17 10 14 5upw'ds 2 ... ... ... 2 ... ... ... 1 2 2 2 Puerperal Fever under 5 ... ... ... ... ... ... ... ... ... ... ... ... 3 5 5 1 5upw'ds ... ... ... ... ... ... 1 ... ... 1 1 ... Measles* under 5 ... ... ... ... ... 5 9 8 1 1 2 3 55 0 0 0 5upw'ds ... ... ... ... ... 8 10 6 ... 1 1 ... Erysipelas under 5 2 ... 1 ... ... ... 1 ... ... 1 ... ... 58 44 35 33 5upw'ds 3 5 5 1 3 3 5 8 6 4 3 7 Totals under 5 5 3 7 2 3 6 14 12 7 2 8 8 77 5upw'ds 21 11 15 7 11 23 24 21 17 21 18 19 208 26 14 22 9 14 29 38 33 24 23 26 27 285 264 204 163 *Only notifiable since June 27th, 1898. T-A-IBXjE! 3. Table of Deaths during the Year 1898, 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 nil Ages. Und'r 1 year. i and und'r 5 6 and und'r 15 15 and und'r 25 25 and und'r 65 65 and upwards 1 2 3 4 6 6 7 8 9 10 11 12 13 14 15 16 Public Institutions being shown as separate localities Small-pox. Scarlatina. Diphtheria. Enteric or Typhoid Fever. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Influenza. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. (a) (b) (c) (d) (e) (f) (g) (b) (i) WIMBLEDON 404 145 43 16 12 96 92 Under 5 ... ... 4 ... 3 2 2 56 ... ... 1 21 1 8 90 188 5 upwards ... ... 3 1 ... ... 1 ... l 2 17 31 33 5 122 216 ATKINSON MORLEY'S HOSPITAL 5 ... ... 1 ... 4 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 3 5 COTTAGE HOSPITAL 4 ... ... ... 2 1 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 4 OURNSFORD ROAD HOSPITAL 2 ... 1 1 ... ... ... Under 5 ... l ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 upwards ... l ... ... ... ... ... ... ... ... ... ... ... ... ... 1 TOTALS 415 145 44 18 14 101 93 Under 5 ... l 4 ... 3 2 2 56 ... ... 1 21 1 8 90 189 5 upwards ... l 3 1 ... ... 1 ... 1 2 19 31 34 6 127 226 The subjoined numbers have also been taken into account in judging of the above records of mortality. Deaths occurring cutside the district among persons belonging thereto. 32 3 1 1 18 9 Under 5 4 4 5 upwards 4 2 6 16 28 Deaths occurring within the district among persons not belonging thereto. 5 1 4 Under 5 5 upwards 2 3 5 TA BLE 4. Table of Population, Births, and of New Cases of Infectious Sickness coming to the knowledge of the Medical Officer of Health during the year 1898, in the Urban Sanitary District of Wimbledon classified according to Diseases, Ages, and Localities. Names of Localities. Population at all ages. Registered Births. Aged under 5 or over 5. New cases of sickness coming to the knowledge of the Medical Officer of Health. Xumber of such cases removed to Hospital. 1 2 3 4 5 6 1 Scarlatina. Diphtheria. Enteric or Typhoid Fever. Puerperal Fever. Measles. Erysipelas. Scarlatina. Census, 1891. Estimatd to Middle of 1898. (a) (b (c (d) (e) WIMBLEDON 25,761 38,000 963 under 5 22 17 ... 29 5 14 5 upw'ds 69 39 11 3 26 53 42 ATKINSON MORLEY'S HOSPITAL Number of Patients 1057 under 5 2 2 ... ... ... ... 2 5 upw'ds 5 2 ... ... ... 3 TOTALS 25,761 38,000 963 under 5 24 19 ... 29 5 16 5 upw'ds 74 41 11 3 26 53 45 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 Health of "Combined Districts" must make a separate Return for the District of each District Council. 2. Vedical Officers of Health acting for 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 art. 3. The words " Urban " " Rural, " or " Metropolitan " must be in erted 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 report 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 1898) 38,000 DEATH RATES. General 10 9 per 1000 Population estimated to middle of 1893. Infant (under one year of age) 150 (per 1000 Births 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 Brought forward 386 1. Miasmatic Diseases 17 V.—LOCAL DISEASES -continued 2. Diarrhoeal „ 56 3. Septic „ 3 6. Diseases of Reproductive System II.-DIETIC DISEASES 2 (a) Diseases of Organs of Generation 1 (b) Diseases of Parturition 1 III.—CONSTITUTIONAL DISEASES 96 IV.—DEVELOPMENTAL DISEASES 47 VI. -VIOLENCE. 1. Accident or Negligence 11 V.—LOCAL DISEASES. 2. Homicide 1 1. Diseases of Nervous System 35 3. Suicide 2 2. Diseases of Circulatory System 36 VII.- ILL-DEFINED AND NOT SPECIFIED CAUSES 13 3. Diseases of Respiratory System 54 4. Diseases of Digestive System 30 5. Diseases of Urinary System 10 Carried forward 386 Total 415 TABLE 5. Distribution and Particulars of Infectious Cases Notified. Diseases. Alexandra Road. Amity Grove. Arterberry Road. Atkinson Morley's Hospital. Berkeley Place. Broadway. Caroline Road. Caxton Road. Cecil Road. Church Road. Clarence Road. Cochrane Road. Common. Copse Hill. Cottenham Park Road. CourtHope Villas. Cowdrey Road. Cowper Road. Cromwell Road. Deburgh Road. Denmark Road. Derby Road. Drive (The) Dundonald Road. Durham Road. Durnsford Road. East Road. Edge Hill. Effra Road. Evelyn Road. Fairlawn Road. Florence Road. Gladstone Road. Goodenough Road. Graham Road. 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. Hill Side. Homefield Road. Diphtheria under 5 ... ... ... 2 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 3 ... ... 1 ... ... ... ... 1 ... ... ... ... 5 upwards ... ... ... 2 ... 1 1 1 ... ... 1 2 ... 1 ... ... ... ... ... 3 ... ... ... ... 1 ... ... 1 ... ... ... ... 2 ... 2 ... 1 3 ... 1 ... 1 ... 3 ... ... ... ... ... ... Erysipelas under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 5 upwards ... ... ... ... 1 1 ... ... ... ... 2 ... ... ... 1 1 ... ... ... 2 1 ... ... ... ... ... ... ... 1 1 ... 2 3 2 ... ... 1 2 ... ... ... 1 ... 5 ... ... 1 ... ... 2 Scarlet Fever under 5 ... ... ... 2 ... 2 ... 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... 2 ... ... ... ... ... ... 5 upwards 1 ... 1 5 ... 2 1 1 ... 1 ... ... 2 1 ... 1 ... ... 1 ... ... ... 2 2 ... 2 ... ... ... ... ... 1 3 ... 3 ... ... 1 1 3 ... 1 2 2 1 2 ... 1 ... ... Enteric or Typhoid under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... Puerperal Fever under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles under 5 ... 1 ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... 1 2 1 3 ... ... ... ... ... ... 1 ... ... ... ... 3 ... ... 1 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 5 upwards 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... 1 ... ... ... ... ... ... 2 1 1 ... ... 1 ... Totals under 5 ... 1 ... 4 ... 2 ... 1 1 1 2 1 ... ... ... ... 1 2 2 6 ... 1 ... 2 ... ... 1 ... ... ... 1 3 2 1 1 1 ... 3 ... ... 2 1 ... 4 ... 2 ... ... ... ... 5 upwards 3 1 2 7 1 4 3 2 ... 2 3 2 2 2 1 2 ... ... 1 5 2 ... 2 2 1 2 1 1 2 ... 5 8 2 6 ... 3 7 1 4 ... 4 2 12 2 3 1 1 1 2 TABLE 5—Continued. Diseases. Home Park Road. Hubert Road. Kenilworth Avenve. Kingston Road. Lancaster Place Latimer Road. Leyton Road. Merton Road. Merton Hall Road. Milton Road. Montague Road. Nelson Road. Newton Road. Norman Road. North Road. North View. Palmerston Grove. PelHam Road. Pepys Road. Queen's Road. Quicks Road. Ridgway. Ridley Road. Riverside Road. Rostrevor Road. Russell Road. Somerset Road. South Place. South Road. Southey Road. Southdown Road. South Park Road. Spencer Hill. Springfield Road. Sunnyside. Tabor Grove. Trinity Road. Victory Road. Vineyard Hill. Wandle Road. William Road. Wimbledon Park Road. Woodside. Worcester Road. Worple Road. Wyclilfe Road. Total. Diphtheria under 5 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 19 60 5 upwards ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... 2 1 2 ... 1 1 ... ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 41 Erysipelas under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 58 5 upwards 1 ... ... 1 ... 1 ... 2 ... ... ... ... 1 ... 1 ... 1 3 1 1 ... ... ... ... ... 1 ... ... ... ... ... 3 1 ... 1 1 ... 1 ... ... ... 1 1 ... ... ... 53 Scarlet Fever under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 3 ... ... ... 2 ... 1 24 98 5 upwards ... ... 2 ... ... ... ... 4 2 ... ... 1 ... ... ... 2 ... 2 ... ... ... 1 ... ... ... 1 1 ... ... ... 1 1 ... 1 ... ... 1 ... 1 4 1 ... 1 ... 3 1 74 Enteric or Typhoid under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 5 upwards ... ... ... ... 1 ... ... ... ... ... ... 2 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 11 Puerperal Fever under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Measles under 5 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... 3 29 55 5 upwards ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... 2 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 1 ... ... ... 3 ... ... 1 26 Totals under 5 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 2 1 ... 4 ... 1 ... ... ... 2 ... ... ... ... 1 ... ... 3 2 ... 1 2 ... 4 77 285 5 upwards l ... 2 1 1 1 ... 7 5 1 1 3 1 ... 3 2 2 5 1 1 2 3 2 ... 1 3 1 2 1 1 6 1 1 1 2 1 3 2 4 1 1 5 ... 4 3 208 TABLE 6. WIMBLEDON URBAN SANITARY AUTHORITY. Table showing Deaths from all causes and at different ages. Cause ok Death. AGES. 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 andupwards Total. Classes. I.—Specific Febrile, or Zymotic Diseases 56 12 6 ... ... ... 1 1 ... ... ... 76 II. — Dietic Diseases ... ... ... 1 ... 1 ... ... ... ... ... 2 III.—Constitutional Diseases 13 11 6 7 8 8 5 18 15 4 1 96 IV.— Developmental Diseases 29 ... ... ... ... ... ... ... 3 11 4 47 V.—Local Diseases 36 18 5 5 11 14 15 15 27 18 3 167 VI.—Deaths from Violence 5 3 1 1 ... ... 2 ... 2 ... ... 14 VII.—Deaths from Ill-Defined and Not Specified Causes 6 ... ... ... ... ... ... 2 2 3 ... 13 Totals 145 44 18 14 19 23 23 36 49 36 8 415 I.-Specific Febrile,or Zymotic Diseases 1.—Miasmatic Diseases. Measles ... 2 ... ... ... ... ... ... ... ... ... 2 Scarlet Fever ... 1 1 ... ... ... ... ... ... ... ... 2 Whooping Cough 2 ... 1 ... ... ... ... ... ... ... ... 3 Diphtheria 1 3 3 ... ... ... ... ... ... ... ... 7 Enteric or Typhoid Fever ... ... 1 ... ... ... ... ... ... ... ... 1 Influenza ... ... ... ... ... ... 1 1 ... ... ... 2 2.—Diarrhceal Diseases Diarrhoea, Dysentery 50 6 ... ... ... ... ... ... ... ... ... 66 3.—Septic Diseases. Erysipelas 3 ... ... ... ... ... ... ... ... ... ... 3 11.—Dietic Diseases. Chronic Alcoholism ... ... ... 1 ... 1 ... ... ... ... ... 2 III.—Constitutional Diseases. Rheumatic Fever ... ... ... 1 ... ... ... ... ... ... ... 1 Rheumatism ... ... 1 ... ... ... ... ... ... ... ... 1 Cancer, Malignant Disease ... ... ... ... 1 2 2 16 11 3 1 36 Tabes Mesenterica 1 ... ... ... ... ... ... ... ... ... ... 1 Tubercular Meningitis, Hydrocephalus 5 8 4 ... ... ... ... ... ... ... ... 17 Phthisis ... 1 1 4 6 3 3 1 1 ... ... 20 Other forms of Tuberculosis, Scrofula 7 2 ... 2 1 3 ... ... ... ... ... 15 Anaemia, Chlorosis, Leucocythæmia ... ... ... ... ... ... ... ... 2 ... ... 2 Glycosuria, Diabetes Mellitus ... ... ... ... ... ... ... 1 1 1 ... 3 IV — Developmental Diseases. Premature Birth 19 ... ... ... ... ... ... ... ... ... ... 19 Atelectasis 1 ... ... ... ... ... ... ... ... ... ... 1 Congenital Malformations 1 ... ... ... ... ... ... ... ... ... ... 1 Old Ago ... ... ... ... ... ... ... ... 3 11 4 18 Marasmus 8 ... ... ... ... ... ... ... ... ... ... 8 V.—Local Diseases. 1.-- Diseases of Nervous System. Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... ... ... ... ... ... ... 2 4 6 ... 12 Epilepsy ... ... ... ... ... 1 ... ... ... ... ... 1 Convulsions 16 3 ... ... ... ... ... ... ... ... ... 19 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... ... ... ... ... 1 ... ... 1 2 Other Dis ases of Nervous System 1 ... ... ... ... ... ... ... ... ... ... 1 2. — Diseases of Cuculatory System. Pericarditis ... ... ... ... ... ... 1 ... ... ... ... 1 Valvular Diseases of Heart ... ... 1 ... ... ... ... ... ... 1 ... 2 Other Diseases of Heart ... 1 1 2 ... 6 2 5 11 3 2 33 3. — Diseases of Respiratory System. Laryngitis 1 1 ... ... ... ... ... ... ... ... ... 2 Bronchitis 2 1 1 ... ... ... 1 2 3 4 ... 14 Pneumonia 8 10 2 1 6 1 6 1 1 2 ... 38 4.— Diseases of Digestive System. Dentition 1 ... ... ... ... ... ... ... ... ... ... 1 Diseases of Stomach 2 ... ... ... 1 1 ... ... ... ... ... 4 Enteritis 5 2 ... ... ... ... ... 1 1 ... ... 9 Obstructive Diseases of Intestine ... ... ... 1 1 ... ... 1 3 ... ... 6 Peritonitis ... ... ... 1 1 2 ... ... ... ... ... 4 Cirrhosis of Liver ... ... ... ... ... 2 1 ... 1 ... ... 4 Jaundice and other Diseases of Liver ... ... ... ... ... 1 1 ... ... ... ... 2 5.—Diseases of Urinary System Nephritis ... ... ... ... ... ... 1 1 2 1 ... 5 Bright's Disease, Albuminuria ... ... ... ... ... ... 1 1 1 ... ... 3 Other Diseases of the Urinary System ... ... ... ... 1 ... ... ... ... 1 ... 2 6.— Diseases of Reproductive System. a. Organs of Generation Female Organs ... ... ... ... ... ... 1 ... ... ... ... 1 b. Of Parturition. Puerperal Convulsions ... ... ... ... 1 ... ... ... ... ... ... 1 VI.—Deaths from Violence. 1.—Accident or Negliqence. Fractures and Contusions ... 1 1 ... ... ... ... ... 1 ... ... 3 Gunshot Wounds ... ... ... 1 ... ... ... ... ... ... ... 1 Poison ... 1 ... ... ... ... ... ... ... ... ... 1 Drowning ... 1 ... ... ... ... ... ... ... ... ... 1 Suffocation 4 ... ... ... ... ... 1 ... ... ... ... 5 2.—Homicide. Murder 1 ... ... ... ... ... ... ... ... ... ... 1 3. —Suicide. Fractured Skull: Jumped from Window ... ... ... ... ... ... 1 ... 1 ... ... 2 VII.—Deaths from Ill-Defined and Not Specified Causes. Dropsy ... ... ... ... ... ... ... ... ... 1 ... 1 Debility, Atrophy, Inanition 0 ... ... ... ... ... ... 1 ... 1 ... 8 Mortification ... ... ... ... ... ... ... ... 2 ... ... 2 Tumour ... ... ... ... ... ... ... ... ... 1 ... 1 Causes not specified or Ill-Defined ... ... ... ... ... ... ... 1 ... ... ... 1