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The increase in the number of cases notified in the earliest years of life is explained by the
increased number of births since the latter part of 1919; some part too of the decrease at ages between
five and ten years is due to the reduction in the population at this age resulting from the lowered birth
rate of war-time; otherwise the decrease in the notifications is much the same for the different agegroups
except of course in those mostly effected by demobilisation. The figures of "primary" notifications
were incorrectly given in the report for last year (page 21) and the above figures should be substituted.
Some axperfs of the Epidemiology of Pulmonary Tuberculosis as exemplified by the statistics of
London Boroughs.
Dr. Greenwood's statistical analysis of these figures in the Annual Report for 1919-20 of the
Chief Medical Officer of the Ministry of Health, and the same writer's Chapter VI. in the Health of the
Industrial Worker by Collis and Greenwood, 1921, raise questions of great practical moment with
regard to Pulmonary Tuberculosis. The main points considered are :—
(a) Migration.
(b) A possible differential effect of adverse home conditions on males and females respectively,
and a possible sensitising influence of industry in promoting this effect in the case of
males.
(c) The three hypothetical types, young adult, middle age and old age phthisis.
Dr. Greenwood's two contributions to the examination of these three problems are models of
lucidity and conciseness; they are if anything too concise; the reader asks for more. In particular,
additional Tables for the younger and older ages (corresponding to that for age 25—45 given in Table 13
on p. 339 of the first-named paper), and more details with regard to the occupations studied, would be
highly valued, indeed, it is to be hoped they will be given by Dr. Greenwood some day. in extenso.
But, here and now, the reader cannot fail to realise that, in Dr. Greenwood's presentment of his
case, the dry bones of Miss Hilda Woods' Industrial Statistics, and of Miss C. M. Thompson's correlation
coefficients relating to the 28 London boroughs, are made to live. The treatment of the last named
material, in particular, appeals irresistibly to the London reader, who sees, or thinks he sees, in his
mind's eye, how the men tend to toil in the central crowded areas, in regions that is of mixed social
character, while the women work presumably in part there also, but mainly in such surroundings as those
of the jam and other factories of Bermondsey and Hackney Wick, the match and other factories of
Poplar, and the laundries, &c., of Hammersmith and Fulham, more outlying localities these and withal
more homogeneous from a social point of view. Again, boroughs with many common lodging houses,
shelters and furnished rooms, Stepney, Southwark, Westminster and Kensington, clearly play their part
in moulding and finishing off Dr. Greenwood's partial correlations. Further, it is apparent that old time
influences extending from former village populations constituting the nuclei upon which London was
deposited, hamlets like the SomersTown of an earlier day, the heart of Merrie Islington, then, much later,
the Kensington Potteries and the Italian and Russian Pole settlements in various parts of the modern
town, all these and their like have contributed informative touches to a picture, which to the undiscerning,
or untutored eye, may merely present a crude cubist or forbidding " partial correlationist "
appearance.
What a unity of opposites London is ! As we study these correlation coefficients and try to probe
their meaning we are reminded of the witches' cauldron, the ingredients of which Shakespeare haled
from such diverse sources. In London there is an analogous medley of races, if not " nose of Turk, and
Tartar's lips," at least specimens of mankind from the wide world over ; such coming and going, and all
transmuted and confused, from what seems in comparison the Arcadian simplicity of Shakespeare's London
of the 16th and 17th centuries, by the bewildering complications introduced in the 18th, 19th and 20th.
II we think only of the changes of the last 80 years, there are the advent of statistics, vaccine therapeutics,
anaesthetics, eugenics and civics, the numbering of the people, the naming of their diseases, modern
medicine and surgery and midwifery (for the drab of Shakespeare's "ditch delivered " babe is now replaced
by the possessor of a Central Midwives Board certificate) to say nothing of the as yet puny efforts, productive
however of such remarkable consequences, of preventive medicine. In particular as regards
phthisis death returns there are the effects produced by the discovery of the tubercle bacillus and the
changes which have resulted from institutional treatment and from immigration and emigration of fit
and unfit. For the influence thus exerted it is true the Registrai General now attempts in part to
supply the necessary " correction," so far as certain migrations within the country are concerned,
but this takes no account of influences associated during life with all the travel to and fro—the