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the importance that has been attached to institutional treatment
as a factor in the diminished fatality of the disease, it is interesting
to notice how long such persons had been removed from their
homes. 22 had been inmates for one week; 40 for less than a
month; 30 for less than three months; the stay of the remainder
exceeding this period. But the length of sojourn before death
does not always give an accurate impression, for I find that of
those who had been in less than a week, 9 had previously received
institutional treatment; while of those who died at home, 63
had previously been in the Infirmary or similar institution, from
which they were discharged at varying periods before death.
Many, probably feeling the oncoming of death, discharged themselves
so that they might die at home. The cases personally
enquired into amounted to 660 of the pulmonary and 180 of the
non-pulmonary. It will be seen that this is less than the total
of notifications sent in, and the difference is accounted for by
the persons having moved away before enquiries could be made.
The difficulty seems to be increasing of finding those at home who
are able to give information, and if the fruitless visits were added
up, it would amount to many times the above figures. Evening
visits and Sundays are in some of these cases effectual in getting
first-hand information; but even with these there remains a not
inconsiderable residuum who never seem to be visible, and it is
the more annoying when, as frequently happens in these instances,
one can hear people moving about inside, but no effort is made to
answer the door. Even when an interview is secured, the information
is given unwillingly, and I fear not always accurately. With
regard to overcrowding and proper sleeping accommodation, the
desire to avoid details is not unnatural, for they fear to be involved
in extra expense. But whatever may be the reason, most of the
people now seem less ready to give information; this is probably
due to a vague fear that information may be used against them,
which one's denial of connection with the School Board man or
someone from the Insurance is not always able to dispel.
In all, 1,887 notifications were sent in relating to 1,054 persons;
in the previous year there were 2,426 notifications relating to 1,519
persons. Some were therefore notified many times, for with a
certain class it is common to be admitted to the infirmary
for a short while, and then to come out only to be re-admitted
after the lapse of a week or so. This operation is not infrequently
repeated several times. A very large number were received from the
dispensary in Brunswick Square, which were proportionately heaviest
among the secondary cases, of which 32 were sent in during the
year. So many are there of such patients, not to mention others who
have been recommended there by various friends or philanthropic
agencies, that it would almost seem, certainly in the poorer districts,
as if the treatment of tuberculous persons by private doctors would
come to an end. We were apparently made aware of nearly all cases,
for, as mentioned above, the persons not notified, if one may judge