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Dr. Niven has commented upon cases from common lodging-houses, and presumed that in many of
these instances the phthisis was contracted in the common lodging-house itself. This is not the general
experience in London. Record has been kept for many years past of the history in fatal cases of
phthisis removed from common lodging- houses. In most of them it is clear that phthisis was already
declared before the man became a common lodging-house inmate (i.e., the common lodging-house was
not responsible for the phthisis). Many of the men had come up from the country; in a few instances
the man dated his illness from the time, pathetically enough in some cases, "when his home was
broken up "or" when he lost his wife." The precise magnitude of the volume of uncared-for old men
who drift up to London is very difficult to gauge. Dr. Niven, as already said, was much impressed by
this phenomenon of old-age male phthisis in Manchester; indeed, it was his observations which led
twelve or fifteen years ago to the undertaking of our London enquiries. In later years, as the annual
censuses of homeless persons each February in London show, the evil so far as this test can be relied
upon has lessened, but taking account of all the mean streets of London housing surveys, there must
be oftentimes more than 100,000 men over 35, in London, in the ranks of casual labour, a considerable
percentage of whom are not Londoners born; and from this army of poverty-stricken humanity the
poorest tenement houses, many of the furnished rooms, and the common lodging-houses and shelters,
draw their clientele year by year.
The mortality upon the later aTches of this Bridge of Mirza (and particularly in the common
lodging-houses) is appallingly high. The results of enquiry concerning 1,138 cases, notified from common
lodging-houses from 1907-1914, was given in the annual report for the year 1914, p. 54. Of the total,
1,069 were men and 69 women. Of the men, 908 were over 35 years of age. In nearly half the total
number, the symptoms of the disease, it transpired, actually developed subsequent to the man's first
entering upon common lodging-house life. The place of birth in 297 of the cases was stated to be outside
London.
Judging by these figures, it may be hazarded at a rough guess (no exact figures can be given) that
nearly a sixth of the recorded phthisis mortality of London is a mortality of men and women (mostly
men) who have only come to London after early middle life. Side by side with this must be remembered
the fact that much of the earlier mortality in born Londoners is not credited to London at all. These
conclusions it may be objected are based largely on mere a priori reasoning. This is not, however, the
case. They are the outcome of much close observation of life in London's mean streets, in the nineties,
and the first ten or twelve years of this century, supplemented by the February census results, by
examination of many phthisis histories, and by study of London phthisis statistics generally.
But it should be noted that the conclusions seem to derive some support from the higher mathematics.
At any rate, as it appears to me, Miss Thompson's coefficients give them a helping hand. Dr.
Greenwood says (p. 340), after considering very carefully the rival hypothesis of the.influence of employment,
"I am far indeed from supposing that this explanation is demonstrated to be true; the statistical
basis is slender, and it would be easy to imagine many other ways in which the particular statistical
results of Miss Thompson might be explained." Here, then, for what it is worth, is an "imagined"
other way, as to the merits of which note will be made immediately.
But first a word as to further help forthcoming from Dr. Brownlee's work on the three types of
phthisis. From this hypothesis some minds probably continue to experience an a priori revulsion. But
to Dr. Brownlee the migration theory is at any rate indebted for a piece of a posteriori evidence which may
be diverted from its original purpose and made to tell in the migration theory's favour. Dr. Greenwood
(Collis and Greenwood, p. 140) alludes to this "extremely important point"; he refers to Dr. Brownlee's
conclusion that "the middle-age type is more susceptible to environment than the others, and the
fact that this is the predominant type in London, Lancashire and the great industrial districts explains
why in these the phthisis rate becomes excessive in the later adult ages; in these districts that type
most responsive to environment prevails." Now it is to be carefully observed that in footnotes, on this
page and on page 141, Dr. Greenwood sounds a warning as to the possible unreliability of Dr. Brownlee's
coefficients, nay even as regards the entire reliability of Miss Thompson's coefficients. This, too, just
when they seemed to promise us help; it is only possible, therefore, to hope for the best. Still one cannot
help noting how much more remarkably Dr. Brownlee's coefficients chime in with the migration hypothesis
than they do with the three-type hypothesis which they are held to confirm. We have seen how the
enterprising and ambitious young people have come up to London, and then in the event of their contracting
phthisis have been prone to leave London, and in many instances to die elsewhere; and how
marked is the drift of older but still ambitious, though necessarily less enterprising, men to London,
where they are too apt to contribute to the mortality from late middle-age or old-age phthisis. Clearly
a priori, on this showing, we should expect Dr. Brownlee's middle-age type of phthisis, in London at any
rate, to seem to respond to environment, for it is just at these middle ages par excellence that the death .
from phthisis is registered in the actual environment in which the disease is developed. Thus it may be
argued we need to invoke no hypothetical types of phthisis to explain the statistics; their explanation
is ready to hand if we are prepared to accept the established facts with regard to migration. The young
people are conspicuous by their absence from the phthisis death returns, partly because they represent
in large measure healthy stock from outside, partly because if they do succumb to the influence of the
London environment they often leave and die outside London. The old people, on the other hand
(men for the most part), who die in London, have in many instances drifted there after contracting
phthisis. Finally the middle-aged phthisics do succumb in considerable numbers in London itself, to
the London environment, mainly for the reason that when they fail they are more likely than the young
folk and the elderly women to remain in London to die, partly also for the reason that at the later middle
ages (among men) the figures, as has been seen, are swelled by immigrants from the country districts for
miles around.