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of all the figures relating to deaths from phthisis ever since they
have been separately recorded. Time will only show whether the
diminution in 1913 forms a step in the regular downward trend of this
disease which has been going on for many years. But as the
decrease is not large, and one that might very well be ascribed to
the indirect measures which are taken against tuberculosis, it may
be well hoped that it is so.
Since the passing of the Insurance Act the number of persons
undergoing treatment in a sanatorium (which must be distinguished
from those receiving sanatorium treatment) has enormously increased,
the Metropolitan Asylums Board alone having received
about 2,000 of them since 1913. But if all suitable cases are to be
treated much more accommodation will be required. The popular
idea is, of course, that every phthisical person should at once be
sent to a sanatorium, for without this a cure is supposed to be highly
improbable; the pressure therefore of public opinion may compel
those in authority to erect still more of these buildings. Yet it is
necessary to remember that many persons do well at a sanatorium,
as indeed they would in any ordinarily good and healthy surroundings;
but when they return to their unsuitable work, their
crowded homes, and to the shortage of food, they lose all the ground
they had gained and rapidly go down hill.
The amount of segregation of the advanced cases which is not
compulsory has been attracting much attention, and part of the
diminution in the mortality from phthisis in late years has been
ascribed to it.
Of the deaths which occurred in infirmaries and other public
institutions within the Borough 19 had been inmates less than a
week, 13 had been there more than one week and less than a month,
62 had been there more than one month, and in 27 other instances
the patient had been in some hospital or infirmary, but had come
out before his death.
The notifications were fairly complete, and out of all the deaths
18 had previously been brought to our notice by the medical
attendant. In the case of non-notification our practice is to write
for an explanation, which in due course comes before the Committee
for their consideration.
The clerical work in connection with this division of the work
shows no signs of lessening, but, on the contrary, of an increase;
more enquiries come in and more returns have to be made. It has
still been necessary to keep on temporary assistance, and I can,
under existing conditions, see no prospect of being able to dispense
with it.
The total number of cases personally inquired into were 955 of
the pulmonary and 230 of the non-pulmonary. It will be seen that
this is less than the number reported by practitioners, and the
difference is partly accounted for by the persons having moved away
before inquiries could be made. This was especially noticeable in
those of the non-pulmonary forms who were notified in the beginning
of the year 1913, for among them quite 10 per cent, had moved