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71
The outstanding feature of these figures is the
heavy and rapid mortality; 21.9% (in 1917) and 36.9%
(in 1922) of the patients dying within a year of their
notification. It is difficult to explain the difference
between the figures for the two periods, but the
obvious deduction from both is that a considerable
proportion of the persons who contract tuberculosis
do not obtain medical treatment until a late stage in
the disease. It is not unreasonable to suppose that
the reason in the majority of cases is the reluctance of
the persons concerned to face the possible loss of
employment and earnings which might follow notification
and treatment.
The figures with regard to sanatorium treatment
are not sufficiently numerous or detailed to establish
any general conclusion. It is, however, reasonable to
assume from them that sanatorium treatment has not,
so far, materially affected the mortality from tuberculosis
in this Borough.
Notwithstanding the impression which might be
created by the foregoing statistics, the tuberculosis
death rate for the Borough during the past twenty
years, and probably for an even longer period, has
declined, like the tuberculosis death rate for the
country. There has been considerable discussion as to
the reasons for this decline, which has been attributed
to the improved standard of living of the workers, to
the work of the tuberculosis dispensaries, sanatoria,
etc., and also, by some medical authorities, to biological
selection. The latter two explanations do not admit
of any very clear measurement, but some information
is available with regard to the first. This is indicated
in an interesting graph which Mr. Lloyd has worked
out, correlating in a general way the general and
pulmonary tuberculosis death rates for England and
Wales and Bethnal Green, with the course of real
wages (i.e., rates of wages as corrected by the cost of
living) during the past 27 years: