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acute pleurisy ; but in other cases no such critical occasion has occurred
and the disease may have developed insidiously but gained rapidly in
intensity over periods so short as two or three weeks. The illness
usually continues to a fatal ending within a short time, and treatment
seems to be without effect in influencing the downward course. This
type of pulmonary tuberculosis has been observed more frequently in
women than in men and closely corresponds to that described by Brownlee
as phthisis of the young adult. A second type of case met with most
commonly in middle-aged men is that of chronic phthisis associated with
chronic bronchitis, and cases of this sort make up fully half of the sufferers
from tuberculosis in the infirmary. The age period in this group is between
the years 45 to 55 and the disease, although very disabling in foggy and
wintry weather, is slow in its progress. Many of the patients enjoy fairly
good health in summer, and some of them leave the institution to resume
such occupations as street hawking, newsvending, etc. The fogs of the
late autumn, however, aggravate their sufferings and they are glad to
return to the shelter and comfort of the infirmary. The type of disease
from which they suffer has been called middle-age phthisis. It is worthy
of note that although the condition continues a slow and chronic course
through middle age, it may assume an acute and rapid phase when
patients reach old age. In those of 60 or 70 years of age, phthisis may
present all the features belonging to the speedily fatal disease of young
adult life.
The infirmary also affords treatment for patients who have experienced
prolonged periods in sanatoria but have failed to respond to all known
methods employed on their behalf. A certain number of cases have been
transferred to the infirmary from sanatorium and have not returned to
their homes. They are thus afforded nursing and comfort which are not
available in their homes and at the same time they are removed from
being a further source of infection to other members of their families.
With regard to cases showing the disease in an early stage or in whom
the diagnosis of tuberculosis was doubtful, 13 were admitted to the infirmary
for observation or pending vacancies in sanatoria and were subsequently
dealt with by the London County Council. The following table shows
the age periods and the diagnosis in 130 new patients examined in the
infirmary during 1924 :—