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INSTITUTIONAL TREATMENT. 71
When an analysis is made of the proportions of deaths in each class of institution (see below),
it is found that the greatest increase above the average has taken place in the deaths in the
hospitals of the Metropolitan Asylums Board. The use of those hospitals has been so much
extended in recent years, and more particularly in the year under review, that the great increase
observed loses much of its significance. The increase in the proportion observed in the case of
lunatic asylums is more significant, small though it be, as it has been almost continuous, a fact to
which attention has been called in previous reports and of which evidence is furnished by Table
VIII., Appendix.

Institutional Treatment of Tuberculosis.
In previous reports this question has been examined solely with a view to test the effect, if
any, of the segregation of the tuberculous (the consumptives) on the mortality, it being
alleged that such segregation has played an important part in producing the acknowledged
reduction in the mortality. The examination hitherto carried out has been confined to analyses
of the duration of institutional treatment of the fatal cases recorded each year. On this occasion
data are available as to institutional treatment in a wider sense—such data being drawn mainly
from the operations of the National Insurance Act, 1911 (Sanatorium Benefit). Incidentally it
may be observed that the operation of that Act has added materially to the work of the Department.
It is anticipated that the tuberculosis work of the Department will be greatly increased,
both in amount and importance, when the proposed schemes for the treatment of the tuberculous
population become effective.
Careful and complete records have been kept in the Department of all applications
for Sanatorium Benefit made by residents of the Borough. Unfortunately there is good
reason to believe that hitherto a certain number of applications have been received and dealt with
by the Insurance Committee without the Department knowing anything about such applications.
It is hoped that in the future better arrangements will be made so as to keep the Department fully
informed of all applications, not merely for statistical purposes but to enable the Department to cooperate
more efficiently with the Insurance Committee and other agencies dealing with the disease.
"Sanatorium Benefit" is granted in four forms:—
(i.) "Domiciliary Treatment"—treatment by the practitioners on the panel either at the
practitioners' surgeries or in the patients' homes;
(ii.) "Dispensary Treatment"—at "approved" dispensaries or occasionally at the patients'
homes by the medical officers of such dispensaries;
(iii.) "Hospital Treatment" in the wards of such hospitals as may have agreed with the
Insurance Committee to receive insured persons; and
(iv.) "Sanatorium Treatment'' at " "approved" sanatoria with which the Insurance Committee
has contracts.
All institutions receiving patients on behalf of the Insurance Committee require to be
"approved" by the Local Government Board.
The first known application for the Benefit from a resident of the Borough was made
in October, 1912, the Benefit having become operative in the previous July, that is, six
months earlier than the other medical provisions of the Act. Before the end of the
year 31 applications were put in, and during 1913 149 applications were made. Of the 180
persons (130 males and 50 females) 119 received the Benefit. Appended is a tabular statement
howing the results of the 180 applications.