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residential treatment of adults, and similarly there has been a considerable demand
from extra-metropolitan authorities for the treatment of persons resident outside
London. Special mention should also be made of those cases discharged as being
unlikely to benefit by further treatment and those discharged as being over age.
Such cases, combined with those for whom there is insufficient accommodation,
whether juvenile or adult, present a serious problem, both from a social and public
health point of view. On the other hand, the establishment of such an institution
as the Winchmore Hill unit has shown that much can be accomplished in mitigating
the results of "pathological delinquency" by the early and continuous medical
observation and treatment of the children in a well-conducted institution.
"Whether the effects of such treatment will be permanent in cases which have been
discharged as definitely improved has yet to be established, but in a number of
cases the improvement has been sustained for several months. Similarly, whether
institutional treatment for adolescent and adult cases would effect an amelioration
of their condition is an experiment which has yet to be made, but there is no doubt
with regard to the need for such an experiment, if only for the purpose of the
classification and subsequent disposal of the patients. A further important reason
for extending the provision of residential treatment of these cases lies in the need
for supplementing the present knowledge of the disease in its various phases by
scientifically studying its later manifestations at close quarters and so applying the
knowledge thus gained to the practical treatment of the disease generally.
This point of view is emphasised in the report by the Medical Research Council
referred to above, in regard to 301 cases of the disease in Sheffield, in the following
passage:—
"These critical studies of a local epidemic of the disease, and the close
and sustained observations of the individual cases of illness throughout their
course which are here recorded, have clear value for all whose business it is to be
concerned with the disease and its treatment. They do not, however, nor do
the careful and prolonged laboratory investigations which have been coupled
with them, throw new light upon the problems of its causation, or give any
guidance towards effective preventive control. This malady, choosing its
victims at random as it now seems to us, has caused and is causing in all classes
some of the most poignant among the tragedies of disease. Our only hope of
overcoming it lies in the acquisition of more knowledge, and we can only expect
to attain this by the sustained and patient prosecution of further studies of the
kind now presented."
Influenza.
The deaths from influenza during 1926 numbered 806, the maximum mortality
being recorded in the 14th week, when 74 deaths occurred. In last year's annual
report an analysis was shown of the periodicity of influenza prevalences in London
since 1890, according to which a prevalence was to be expected about the 3rd week of
1927. Influenza became epidemic at the end of 1926 and reached a maximum
mortality in London in the 4th week of 1927, when the deaths numbered 252. The
table of periodicity referred to shows that while there has been no epidemic with a
maximum on the 4th week of the year, there have been three reaching a maximum
in the 3rd week and two in the 5th week, the interval to the next following epidemic
being from 54 to 69 weeks. In the present case, where the maximum falls on the 4th
week, the table of periodicity suggests the probability of an epidemic in April, 1928,
having a maximum about the 13th week of the year.
Tuberculosis.
The deaths from tuberculosis of the respiratory system in London during
1926 numbered 4,066, giving a death-rate of 0.88 per thousand, corresponding
figures for 1925 being 4,361 and 0.95 respectively. Deaths from other forms of
tuberculosis numbered 691 as against 796 in the preceding year, the death-rate