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171
a well-to-do population is high, and malnutrition, a factor of the utmost
importance in the tuberculosis problem, is little in evidence. Hampstead,
by reason of its situation and elevation, has a reputation as a
healthy district, and this is borne out by its low tuberculosis death-rate.
This reputation as a Health Resort, tends, however, to bring to Hampstead
a number of tuberculous immigrants from other parts of London,
and this also applies to many tuberculous persons from the Provinces
who come to London to live. One would expect this factor to have an
adverse influence on the death-rate. A further point of interest is the
presence amongst the population of Hampstead of a large number of
Domestic Servants. Many of these come from Wales, Ireland and the
"depressed areas" of the North of England. Previous experience has
shown that they form a very susceptible group, and as one would
expect, numbers of them become victims of tuberculosis. In a very
large number of cases they suffer from malnutrition and many come
from tuberculous homes. There is little doubt that some of them have
been heavily infected previously, and that open tuberculosis represents
a break down of a quiescent focus under the strain of urban life. Rut
this section of the population, although occupying a prominent part in
the Dispensary Register, does not very materially affect the death-rate,
for most of these patients return to their homes in Wales, Ireland,
Durham, etc., before or after they have received Sanatorium treatment.
Experience in the Tuberculosis Service in Wales fully bears out this
assumption; in the Tuberculosis Dispensaries there, numbers of girls
who have worked in towns and cities in England are seen on their
return home after the onset of tuberculous disease.