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20
Under the Public Health (Tuberculosis) Regulations, 1924, the Medical Officers
of Health are required to prepare, from the register of notified cases of tuberculosis,
a quarterly return showing the number of cases on the register at the commencement
and at the end of the quarter, and the number added to and removed from registers
during the same period. The returns under this order received from the several
metropolitan boroughs, show that at the end of 1926 there were 40,205 cases of
pulmonary tuberculosis (23,027 males and 17,178 females) on the Registers of the
Metropolitan Boroughs and 15,762 cases of other forms of tuberculosis (8,293 males
and 7,469 females).
Mortality
from
pulmonary
tuberculosis
among
adults.
In comparing the incidence of phthisis in different populations, too little
attention has been paid to the relative health of the populations concerned. The
simplest and most obvious measure of the health of the population is afforded by the
death-rate from all causes, especially when consideration is being given to the mortality
amongst adults.
It has been shown in earlier reports of the County Medical Officer of Health that
the mortality from tuberculosis is intimately associated with "social condition."
The mortality-rate from phthisis in London boroughs of the poorer class in the ten
years, 1901-1910, was two or three times greater than among boroughs of better class
populations. It might from this be supposed that there are some particular conditions
prevailing among the poorer classes which are specific factors in phthisis
causation, such as, increased risk of infection due to overcrowding; insanitary
conditions generally; or intemperance, etc. It will, however, be seen from the accompanying
table that when the mortality from phthisis is stated as a percentage of the deaths
from all causes at each age period, much of the difference between the three groups of
boroughs of different social circumstance disappears.
Group I contains boroughs with a large proportion of well-to-do residents;
Group II. is an intermediate group approximately to the London average, and
Group III represents boroughs of the poorer classes. The rates are per 100,000 living
in each age-group:—
Phthisis death-rate in Group. Phthisis per cent. of all causes.
Age period.I. II. III. I. II. III.
Males.
5-15 11 14 17 5 5 6
15-25 107 105 132 35 33 35
25-45 219 271 341 33 36 37
45-65 03 398 513 14 16 19
Total of Rates 640 788 1,003 87 90 97
Total, GroupI=100 100 123 157 100 104 112
Females.
5-15 21 23 27 9 8 9
15-25 67 80 105 32 32 34
25-45 112 144 207 25 26 29
45-65 123 154 224 8 9 10
Total of Rates 323 401 563 74 75 82
Total, Group I=100 100 124 174 100 103 112
In the comparison of phthisis mortality rates in groups of London boroughs,
arranged according to "social condition," two points require to be borne in mind.
In the first place, the proportion of persons suffering from phthisis who will be able
to leave London and take up permanent residence in a more suitable locality must
necessarily be greater in the better class boroughs and, as a consequence, the deathrate
of the group which includes these boroughs will be relatively understated. Also,