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returns forwarded to them by their own nurse. Up to the
present no complaint has been received from the London County
Council with regard to our charges.
I might incidentally mention that before definite arrangements
were made with regard to payment for cleansing of verminous
children, this Council had carried on the work for upwards of two
years without any question of payment. But, after the agreement
was finally settled with regard to the payment in future, the London
County Council promised to pay the Council for the past work, and
suggested that we submit an account. The work of making out this
account, the major part of which was done by Messrs. Harman
and Sawyer, meant that each separate entry in the latter's register
had to be examined, and each child charged up separately. The
work was long and tedious, and it necessitated their attendance at
the Town Hall many nights for several hours at a time to
complete the work.
It was, however, so well and accurately done that the account,
which amounted to £271 16s., was, according to the intention of the
London County Council, to be checked by our register, but when they
found what a huge task they had in hand, they apparently were so
satisfied with the way in which the account had been prepared that
they decided to pay the amount without any question of checking.
The number of deaths registered in London from phthisis
amounted to 6,084, an increase of more than 500 over 1910. Those
in Camber well have increased from 300 to 338. The death rate in
Camberwell was 1.34, which is only 1 below that for the whole of
the County of London, whereas in 1910 we were .6 below. The
increase in the death rate being calculated differently for the whole
of the County in the two years, the one being an estimate and the
other the census enumeration, is not quite available for the purpose
of comparison. The rate for 1910 is too low, both for the County
and the Boroughs, so that the increase is not so great as
appears. Nevertheless, the hard fact remains that instead of
there being a decrease in the mortality due to the greater attention
paid to the prevention of presumed infection with all its attendant
circumstances, there has been an actual increase. Various reasons
have been assigned for this, one being that from the increased interest
taken in consumption and the greater facilities for diagnosis, we
must expect many more cases to be diagnosed, with a consequent
swelling of the death returns. But whatever might be one's opinion
as regards now and ten years ago, it is difficult to think that
between 1910 and 1911 there has been such an enormous improvement
in the means of diagnosis to account for the rise. It has also
been pointed out that while improved diagnosis may lead to the
inclusion of cases of phthisis which would formerly not be so
included, it may also lead to the exclusion of those cases which in
previous and less accurate years would have been so considered, so
that this is obviously an argument which cuts both ways.
Judging from the number of cases that are sent for examination,
it is certain that in many instances it is suspected and that bac-