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In Table II. it will be noted that eleven cases of pulmonary
tuberculosis were not notified to me before death, an actual
increase of four over the number of such cases in 1931. Of these
11 cases 4 males and 1 female were aged 56 years or over at death
and had been admitted to the local general hospital only a short
time before death. Another female, aged 32, died out of the
district and had not been resident in the borough for a considerable
period before death. With regard to the 5 remaining males
(aged 16—37), on 2 of whom inquests were held, death occurred
suddenly or the diagnosis remained in doubt until the end. Thus,
although there has been a small increase in the number of unnotified
deaths there is no evidence to suggest that there has been
any relaxation amongst medical practitioners in their efforts to
comply with the notification regulations.
I am pleased to report that there was a decline in the number
of deaths due to miliary or meningeal tuberculosis, amongst
children aged 10 and under. In 1932 these numbered only 4
compared with 16 in 1930 and 11 in 1931. It is difficult to
account precisely for this decline. Advantage is taken of the
London County Council's scheme for the boarding out of children
from homes where there is an infectious case of tuberculosis in
the family and approximately 15 children are sent away each
year. Difficulty, however, is always experienced in persuading
parents to part from infants, who are of course the most susceptible
to the disease, and the majority of children "boarded
out" are of school age.
It seems possible that one of the deciding factors in the
decline is the increased use of the local hospital for the admission
of active and advanced cases. The Tuberculosis Officers, who
are known to the patients and their families, visit the hospital
regularly and this has, without doubt, helped to keep in the
institution many who would otherwise return home and remain a
source of infection to others. Attention was drawn, in a previous
report, to the importance of human infection in cases of miliary
tuberculosis. Of the 4 children, all males, who died in 1932, 3