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bringing 'unsalted' populations into contact with urban civilisation." He continues,
"perhaps what happens to an extreme degree when Dryden's noble savage
becomes a townsman happens to a less degree when Corydon repairs to the tenement,
the picture palace and the factory." He concludes, "adolescent migration perhaps
increases mortality in both populations—rural mortality by the withdrawal of those
best fitted to survive under the rural environment, urban mortality by the introduction
of those ill-adapted to survive under urban conditions." Upon this it
might be suggested that the tendency, which has become so marked in the last
few years, for young girls to exchange "living-in" as domestic servants for "livingout,"
may have operated prejudicially upon their health. The domestic servant,
who formerly was well-housed and well-fed and cared for, has now in many
thousands of instances repaired "to the tenement, the picture palace and the
factory," and this change may perhaps find some reflection in the phthisis death-rate
at 15-25.
In his concluding lecture Dr. Greenwood returns to the problem of internal
migration and examines the case of the boot and shoe or slipper makers of Northants
and Leicester, who have an even higher phthisis mortality than the textile workers
of the North. He speculates as to whether inward movement, of "unsalted youth,
of genuine rustics," from within 50 miles of the great Midland boot factories, materially
contributes to this high mortality; but the acquirement of direct evidence
bearing upon the question is, he finds, difficult. He points out, however, that "the
conditions of life to which the youth in the country is exposed, are widely different
from those awaiting him as a factory employee. He refers to the observations
of the late Dr. Edward Smith, F.R.S., on the health of the London printers, that
"usually they are pale and thin with sunken features and large pupils, but in other
cases they are fleshy and have colour, and do not show a low type of health. Very
generally they affirm that they are well, take their food heartily and digest it well,
and have not degenerated in health." He adds, "it has been stated that country
boys sooner lose flesh and colour than town boys, and are among the earliest to fall
into serious disease." Dr. Greenwood thereupon proceeds to examine (assuming
that a change from rural conditions to urban life is a factor of sickness and mortality)
the mechanism of the deterioration. He suggests three contributory causes (i.)
change of diet, (ii.) reduction of bodily exercise, (iii.) the immediate effects of atmospheric
change. Dr. Greenwood concludes by quoting the words of his predecessor,
the Milroy Lecturer of 1903, Dr. Bulstrode. It is, indeed, remarkable, looking
back over the 20 years, to note how accurately Dr. Bulstrode diagnosed the
needs of the situation, as it presented itself in 1903, and how much, as Dr.
Greenwood says, " has been done in the last 20 years to satisfy these requirements."
The number of notifications of tuberculosis in London during 1922 (52 weeks)
was 11,548 as against 12,214 in 1921. Of these 9,327 were pulmonary and 2,221
other forms of tuberculosis. These figures compare with those published in these
reports prior to 1921. Further correction of the figures by the exclusion of cases
notified as primary but eventually found to have been previously notified, brings
the total number of pulmonary cases down to 7,826 and other cases to 2,158, the
corresponding figures for last year being 8,460 and 2,188.
Notification
of tuberculosis.