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59
Report of the Medical Officer of Health.
As the result of enquiry, information was obtained in respect of 185 of the patients as to
whether their illness began before or after they had resorted to this mode of living. Of the total
(185) the onset of illness was stated in 69 cases to date from a time prior to that when resort was
made to common lodging-houses, while in 12 other cases it was practically coincident with entry. As
regards cases developing after commencement of this mode of life, in 36 cases the illness was
first manifested before the expiration of three years; in 13 in from three to five years ; in 28 between
five and ten years; in 18 between ten and twenty years; and in 9 cases the illness developed after
more than twenty years of common lodging-house life.
It is too early to estimate with any sufficient accuracy the total number of persons suffering
from recognisable phthisis in the general population, but it may be stated that the figures at present
available indicate that the number of persons notified under the Regulations requiring the notification
of phthisical persons attending hospitals and dispensaries exceeds those notified in poor law practices.
Moreover, it may be expected that any measure increasing the facilities for the medical treatment of
the population will tend to increase the number of persons who are found to be suffering from pulmonary
tuberculosis, but even the figures which will then be arrived at will not indicate the whole
of the persons so suffering. The trend of knowledge of the behaviour of tuberculosis in the general
population is to show that a considerable number of persons are at one or other period of life attacked
by tuberculous infection, that in many so attacked this invasion is overcome, while in others the
powers of resistance are insufficient and recognisable illness and often death ensues. The important
fact, however, remains that the London death-rate from phthisis has been declining for more than
forty years, and during this period has fallen some 60 per cent., and this not as the result of any effort
especially directed to the prevention of this disease. Assuming that the figures have not been
materially affected by changes in nomenclature, it is difficult to believe that this result is not due to
an actual or relative increase of ability to resist infection, whatever the cause or causes of this increase
mav be.

Decrease per
cent, in the
phthisis
death-rate,
England and
Wales and
London,
Nearly all of the annual reports give account in more or less detail of the steps taken in connection
with cases of pulmonary tuberculosis which came to the knowledge of medical officers of health.
These steps include visits to the homes of patients, the giving of advice which aims at the safeguarding
of other persons, and the adoption of measures in the interest of the sufferers. In many of the reports
the institution of anti-tuberculosis dispensaries is recommended by the medical officers of health.
Such a dispensary was provided in Paddington, and its use extended to the inhabitants of Kensington
and another was provided in St. Marylebone. In Hampstead, Hackney, Stoke Newington, Wandsworth
and Greenwich the medical officers of health recommend the institution of a dispensary, and similar
provision was contemplated in Fulham and Battersea, in the report relating to Greenwich the opinion
being expressed that it would be well for the work to be undertaken by an existing institution.
A conference of sanitary authorities was held in May, 1910, at which resolutions were adopted
(a) that the provision of sanatoria for the educational and curative treatment of tuberculosis is
desirable, (b) that such provision for the use of the metropolis should be made by the Metropolitan
Asylums Board, (c) that pending such provision the sanitary authorities should secure beds in
existing sanatoria, and (d) that the establishment of a dispensary in each metropolitan borough
was desirable. The annual reports show that the Kensington Borough Council decided to secure
one bed at Benenden or elsewhere, and authorised five others to be utilised as required ; that the
Westminster City Council sent 26 patients to sanatoria; the Bethnal Green Borough Council engaged
six bedg for 12 months at the Fairlight Sanatorium; the Southwark Borough Council five beds at
Benenden ; and at Woolwich the borough council continued the use of seven beds at Peppard. Dr.
Da vies writes favourably of the results obtained in Woolwich, and describes a " shelter," two of
which are provided by the borough council for the use of consumptives, and in which they sleep at
night, going to work during the day. The Kensington Borough Council has also decided to provide
shelters as required.
The home conditions of some of the cases of phthisis in Hackney brought to the knowledge
of the medical officer of health are well shown in Dr. Warry's report relating to that district. In six
instances a patient occupying a single room shared it with other persons, in two instances with one
and in four instances with two other persons. In forty-seven instances the patient occupied two
rooms with other persons, in thirteen instances with two, in ten with three, in twelve with four, in
eight with five, and in four with six other persons. Similar information is given in respect of the
occupation of three and four rooms by patients. In Kensington the borough council authorised the
purchase of an additional bed where this was needed to obviate the necessity of persons sleeping in
the same bed as the natient.
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