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TUBERCULOSIS. 23
Failure of Notification.— During the two years 65 deaths (36 in 1919, 29 in 1920) certified
due tu tubercle were not notified to the Department daring the lives of the deceased persons—
i.e., 23.3 per cent, of tuberculous deaths were "non-notified." During 1914-18 the percentage
of such deaths was 19'8 per cent.
Of the non-notified deaths 33—more than half—occurred in institutions outside the
Borough, including 11 in lunatic asylums. A small proportion of the cases of patients dying
outside the Borough (35 in all) had been notified to the Medical Officers of Health ot the
districts in which the patients died. Enquiry is made with reference to every non-notified
death, but the results of the enquiries muse be reserved for consideration elsewhere.
In 22 instances during 1919-20 the notification certificates were received after the patients
died and in 103 other instances death ensued within 6 months after notification. Combining
those figures the result is that of 774 cases notified during 1919-20, no fewer than 125 (16.1 per
cent.) were dead within 6 months. The corresponding proportion for 1914-18 was 14.7 per
cent. Having regard to what has been written on the duration of the disease, the fact of so
many deaths at such intervals after notification cannot be regarded as satisfactory and the
increase in the proportion noted during the past two years is even more unsatisfactory.
Institutional Mortality.—Of the 133 deaths from all forms of tuberculosis recorded in 1919
71 (53.4 per cent.) occurred in institutions of various characters. In 1920, 81 out of 146 such
deaths—55.4 per cent.—were institutional deaths. Of the deaths from pulmonary tuberculosis
45.7 per cent, occurred in 1919 and 55 per cent, in 1920, as compared with averages of 48.3 and
54.4 per cent, during the quinquennia 1909-13 and 1914-1918.
Of 28 deaths from non-pulmonary tuberculosis 23 (82.1 percent.) took place in institutions
and of 26 in 1920, 15 (57.7 per cent.) During 1909-13, the average percentage was 50.2 and
that during 1914-18, 69.3.
The variations in the proportions of the deaths of the sexes in institutions are shown below.
No explanation can be offered of the somewhat erratic changes.

During 1919-20 records of frequency of admission to institutions were obtained with
respect to 105 deaths from pulmonary tuberculosis—77 of the deceased having received such
treatment once, 17 twice and 11 on three or more occasions. In comparision with the records
for 1914-18, the figures for the last two years show a slightly smaller proportion (26.7 per cent.)
than in 1914-18 (29.1 per cent.) The recorded average duration of treatment of the 105 cases
was 4.12 months, exactly the same as in 1914-18.
The variations in the proportions dying in different classes of institutions are remarkable
and except as regards Mental Hospitals, difficult to explain. (See below).