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20 tuberculosis.
Non-notified Deaths.—If the Tuberculosis Regulations 1912 were strictly complied with,
the instances of death from tuberculosis being the first report to the Department of the
disease should be very few, and should be limited to sudden deaths of persons in whom the
disease was not diagnosed during life and of those who succumbed to very acute attacks of
the disease. During 1914-18 there were 205 deaths of residents of the Borough due to
various forms of tuberculosis, such deaths being the first intimation to the Department of
those persons having the disease. In addition 75 persons died from tuberculosis, the
notification certificates with reference to which were received after death. The total
"non-notified" (fatal) cases amounted, therefore, to 280, equal to 27 per cent. of the
total deaths (1,035) ascribed to tuberculosis in all its forms. Of the 280 deaths 9(5 (47 per
cent.) occurred within the Borough (64 at the deceased persons' homes and 32 in local
institutions), and 109 (53 per cent ) were " transferred " deaths, i.e., took place outside the
Borough (in different parts of England and Wales), and were reported to the Department
through the General Register Office. Of these 109 deaths, 95 occurred in institutions. A
full analysis has been made of the 280 deaths with a view to ascertaining the reasons for
"non-notification," but the results of such analysis cannot be included here. So considerable
a "leakage " as 27 per cent, (of fatal, not all, cases) cannot be regarded as anything but
very unsatisfactory.
Deaths in Institutions.—The "segregation," i.e., isolation in institutions of advanced
cases of pulmonary tuberculosis, has been urged as a factor of high import in the control
of tuberculosis.
The proportion of tuberculous patients isolated cannot be given, as the knowledge of
the prevalence of the disease is very incomplete. Some evidence of increase in public
appreciation of institutional treatment is afforded by a review of the proportions of patients
who die in institutions. During 1909-13 350 of the 724 deaths from pulmonary tuberculosis
took place in institutions (of all kinds), and during 1914-18, 450 out of 826. In the former
period the institutional deaths were equal to 48.3 per cent. and in the latter to 54.4 per
cent.—an increase of 12*6 per cent.
The total deaths from non-pulmonary tuberculosis during 1909-13 numbered 221, of which
111 (50.2 per cent ) occurred in institutions, the corresponding figures for 1914-18 being 209
and 145 (69.3 per cent.) showing an increase of 38 per cent. in the latter period. Below are
shown the percentages of deaths in institutions of males and females in the two periods.

The increases in the proportions shown above are equal to—in the case of males—
pulmonary tuberculosis, 9 per cent., non-pulmonary, 31, and, in the case of females, 21 and
31.
The percentages of tuberculous deaths occurring in the various classes of institutions
were—

No fewer than 260 of the 450 deaths attributed to pulmonary tuberculosis occurred in the
Paddington and St. Marylebone Infirmaries. Of the 34 deaths in the Metropolitan Asylums
Board's Hospitals, 4 occurred in hospitals not set apart for the treatment of pulmonary
tuberculosis.
The deaths from tuberculosis (all forms) in mental hospitals (lunatic asylums) numbered
85, and were equal to 17.2 per cent. of all deaths (494) in those institutions—in the rest of
the "population " of the Borough the proportion was 9.6 per cent.
Fairly complete information was collated relating to 396 deaths from pulmonary tuberculosis
in institutions other than mental hospitals. The duration of treatment in such
institutions averaged a little over 4 months (4.12). The numbers of times the deceased
persons had been in institutions are shown on the next page.