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Report of the County Medical Officer-General.
49
When attention is directed to the percentages of deaths occurring at this period great variation
will be noted as might be expected from the small number occurring at this age in a single year, yet those
in boroughs which have a high case incidence at 5-15 years are without exception below the average
for the county. On comparing the notification under the different orders it appears that the majority
at this age period were from hospitals, dispensaries, and similar public institutions and were notified
under the Tuberculosis (In Hospitals) Order. It is perhaps easier for children to attend at hospitals
than adults, so that it might be expected that the proportion would be highest in those boroughs where
the facilities for hospital attendance are the greatest. This, however, is not entirely the case since
boroughs such as Bethnal Green and Holborn both well served by hospitals, present a very small proportion
of notifications at this age, while Woolwich, from which access is less ready, presents a very
high proportion.
The factor of special interest in the areas whence come some of the high frequencies of tuberculosis
at the age period 5-15 years, is the presence of special dispensaries for diagnosis and treatment, which
seek out contacts and encourage their attendance for examination. It is probable that they may find
it easier to secure the examination of the younger individuals and indeed it appears from the report of
the Central Fund for the Promotion of Tuberculosis Dispensaries in London, that 34 per cent. of those
they examine are under the age of 15 years, whereas the proportion at this age of the whole population
was 28.8 per cent. The disparity between the indication from the death rate, the Poor Law notification
and notification from general practitioners shows that there are in different areas different standards
of what constitutes notifiable tuberculosis.
The percentage of patients with pulmonary tuberculosis at the age group 5-15 years attending
the Hospital for Consumption, Brompton, was 5.4 in 1842-1848 and 5.3 in 1902-1908, figures which show
remarkable constancy and may be regarded as indicating the proportions whose condition attracted
attention, and it will be noted that changed methods over the course of years had little influence on
the proportions. It must be remembered that many under 12 years of age might go to Children's
Hospitals.
Some indications are given in the reports of medical officers of health as to the nature of treatment
received by the patients in the cases notified. While the bulk of the cases notified under the Poor Law
Order receive indoor institutional treatment in the infirmaries, or, in some instances where beds are at
the disposal of the guardians, in sanatoria, the majority of the patients notified from hospitals and private
sources are treated at home. Thus, in St. Marylebone, of 155 cases notified under the Poor Law Order,
109 were treated in the infirmary; of 448 notified under the Tuberculosis Order, 35 were admitted to
hospital or infirmary, and 393 were treated at home ; while of 107 notified from other medical sources
only three received residential institutional treatment.
Some idea of the range of residential treatment at present available is indicated by a return from
the City of Westminster, which shows that 331 cases were distributed as follows:-Sanatoria, 73;
convalescent homes, 26; boarded out, 11; consumption hospitals, London 16; consumption hospitals,
seaside, 18; homes for the dying, 7; general hospitals, 31; Poor Law infirmaries, 149. Returns from
seven metropolitan boroughs show the percentage proportion of fatal cases treated in different institutions
to have been-Infirmaries, 40.8 ; hospitals, etc., 13.1 ; at home, 46.1.

The evidence afforded by this table would seem to indicate a considerable constancy in duration
in spite of economic and medical changes.
In the reports of the medical officers of Bethnal Green and Woolwich reference is made to patients
who have been sent to sanatoria by the borough councils. The first-mentioned medical officer does not
regard the results as a great success owing to the return of patients to unsatisfactory surroundings,
while the latter thinks that from 4 to 5 months would be better than the usual period, from two to three
months, spent at an institution, and indeed, recommends a period of from one to two years. Of 237
patients who have left the sanatorium within the last nine years, 107 are known to be dead, 15 to be
alive but under treatment, and 75 to be at work or looking for work.
18820 G