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Reduction in mortality from phthisis
226
THE
BRITISH
JOURNAL
OF TUBERCULOSIS
PERSONAL OPINIONS. REDUCTION IN MORTALITY FROM PHTHISIS. BY J. E. B U L L O C K , M.D., I~I.R.C.S.
A STUDY of the Annual Summary for 191o 1 recently issued by the Registrar-General shows a very satisfactory reduction during the year in the deaths f r o m phthisis of persons belonging to London. T h e deaths numbered 5,555 (3,437 males and 2,118 females), corresponding to a rate of 1.14 per i,ooo living, or o'24 below the average rate in the five preceding years. T h e mortality in the several boroughs, after distribution of deaths in public institutions among the boroughs in which the deceased persons previously lived, ranged from 0"55 in Lewisham to I'98 in Holborn. In the following boroughs it was below i ' o o : Hampstead, 0"59 ; Kensington, 0"77 ; Paddington, 0"84 ; Wandsworth, 0'86 ; Stoke Newington, o'91 ; Greenwich and Fulham, 0 9 4 each. In the following it was above I'OO : Woolwich, I'OI ; Battersea, 1"o3 ; Hammersmith, I'O4 ; Hackney and Camberwell, i'o8 each ; St. Marylebone, I ' I O ; City of Westminster, i"12 ;' Islington, I ' I 3 ; Chelsea, ~'i6; Lambeth, v i 7 ; Deptford, 1"19; St. Pancras, 1"28; Stepney, I'31 ; Poplar, 1"36 ; Bethnal Green, i'43 ; ~horeditch, i'49 ; Finsbury and City of London, I'7 ° each ; Southwark, i'74 ; Bermondsey, 1"76. It was below the average for the preceding five years in every borough. In Edinburgh the rate per I,OOO was o'97 ; in Glasgow, i ' 2 i ; in Dublin, 2"34 ; in Belfast, 2"ii. The very low rate in Edinburgh may be considered due to the benefits of the Tuberculosis Dispensary system (so admirably worked under the initiative of Dr. Philip), the benefits of which have extended to Glasgow. Dublin and Belfast have improve d under the energetic anti-tuberculosis campaign in Ireland. In the five years, I88i-i885, the deathrate from phthisis of London and Edinburgh were nearly equal (2"22 and 2"12 per I,OOO), and have steadily declined since, but (as stated a b o v e ) i n I9iO the death-rate for London was 1.14 as against o'97 for Edinburgh. In the same five years the death-rates for Glasgow, Dublin, and Belfast were about equal ; Glasgow and Dublin " A n n u a l Summary of Marriages, Births, and Deaths in England and Wales and in London," I9IO, published by authority of the Registrar-General.
PERSONAL
OPINIONS
227
have steadily declined since ; Belfast remained stationary for the first fifteen years, but since i895 has shown a marked decline. A corresponding favourable decline in mortality attributed to phthisis has occurred in many other countries, but not to the same extent as in London and Edinburgh. For 191o the death-rates per I,OOO are as follows : Rio de Janeiro, 3"9@ Paris, 3"66 ; Trieste, 3"56 ; St. Petersburg, 2"90 ; Breslau, 2"59 ; Moscow, 2"50 ; Vienna, 2"49 ; Milan, 1"9o ; New York, 1"81; Berlin, 1.76 ; Turin, 1"66; Dresden, 1"52 ; Amsterdam, 1"3o ; Hamburg, 1"26 ; Rotterdam, 1:21 ; Copenhagen, 1"14 ; T h e Hague, 1"12. In Australia we have the satisfactory figures of i'oo for Melbourne, and o'72 for Sydney. All the above towns show a steady decline in each quinquennium since 1881-1885. In London, the percentage of deaths at home as against deaths in public institutions (hospitals, homes and sanatoria, workhouses and lunatic asylums) was over fifty ill the following boroughs : Kensington, Hampstead, Paddington, Stoke Newington, Lambeth, Battersea, Wandsworth, Lewisham, and Woolwich. I11 nearly every London borough more females than males died at home. T h e proportion of deaths in public institutions was greater in those boroughs in which the conditions are such as to render more difficult the control of the disease, when the patient remains at home--e.g., in Holborn, which had the highest death-rate from phthisis, 7o'7 per cent. males and 60"9 females died away from home. The Registrar-General remarks : ~' It may fairly be urged that in districts (like Holborn) the conditions favour the spread of the disease so much that without segregation, the death-rate might well have been higher still." It is too early yet to comment upon any reduction in the mortality from phthisis in the three London boroughs of Paddington, Kensington, and Marylebone, in which Tuberculosis Dispensaries have been established, but there is every reason to hope that these dispensaries will have a marked effect in diminishing the mortality. In London most deaths have occurred between the ages of thirty and forty-five, both in males and females, but in females more ha'qe died under thirty than over forty-five; hence it appears that the power to resist the disease, as age advances, is less in females.
THE
BRITISH
JOURNAL
OF TUBERCULOSIS
PERSONAL OPINIONS. REDUCTION IN MORTALITY FROM PHTHISIS. BY J. E. B U L L O C K , M.D., I~I.R.C.S.
A STUDY of the Annual Summary for 191o 1 recently issued by the Registrar-General shows a very satisfactory reduction during the year in the deaths f r o m phthisis of persons belonging to London. T h e deaths numbered 5,555 (3,437 males and 2,118 females), corresponding to a rate of 1.14 per i,ooo living, or o'24 below the average rate in the five preceding years. T h e mortality in the several boroughs, after distribution of deaths in public institutions among the boroughs in which the deceased persons previously lived, ranged from 0"55 in Lewisham to I'98 in Holborn. In the following boroughs it was below i ' o o : Hampstead, 0"59 ; Kensington, 0"77 ; Paddington, 0"84 ; Wandsworth, 0'86 ; Stoke Newington, o'91 ; Greenwich and Fulham, 0 9 4 each. In the following it was above I'OO : Woolwich, I'OI ; Battersea, 1"o3 ; Hammersmith, I'O4 ; Hackney and Camberwell, i'o8 each ; St. Marylebone, I ' I O ; City of Westminster, i"12 ;' Islington, I ' I 3 ; Chelsea, ~'i6; Lambeth, v i 7 ; Deptford, 1"19; St. Pancras, 1"28; Stepney, I'31 ; Poplar, 1"36 ; Bethnal Green, i'43 ; ~horeditch, i'49 ; Finsbury and City of London, I'7 ° each ; Southwark, i'74 ; Bermondsey, 1"76. It was below the average for the preceding five years in every borough. In Edinburgh the rate per I,OOO was o'97 ; in Glasgow, i ' 2 i ; in Dublin, 2"34 ; in Belfast, 2"ii. The very low rate in Edinburgh may be considered due to the benefits of the Tuberculosis Dispensary system (so admirably worked under the initiative of Dr. Philip), the benefits of which have extended to Glasgow. Dublin and Belfast have improve d under the energetic anti-tuberculosis campaign in Ireland. In the five years, I88i-i885, the deathrate from phthisis of London and Edinburgh were nearly equal (2"22 and 2"12 per I,OOO), and have steadily declined since, but (as stated a b o v e ) i n I9iO the death-rate for London was 1.14 as against o'97 for Edinburgh. In the same five years the death-rates for Glasgow, Dublin, and Belfast were about equal ; Glasgow and Dublin " A n n u a l Summary of Marriages, Births, and Deaths in England and Wales and in London," I9IO, published by authority of the Registrar-General.
PERSONAL
OPINIONS
227
have steadily declined since ; Belfast remained stationary for the first fifteen years, but since i895 has shown a marked decline. A corresponding favourable decline in mortality attributed to phthisis has occurred in many other countries, but not to the same extent as in London and Edinburgh. For 191o the death-rates per I,OOO are as follows : Rio de Janeiro, 3"9@ Paris, 3"66 ; Trieste, 3"56 ; St. Petersburg, 2"90 ; Breslau, 2"59 ; Moscow, 2"50 ; Vienna, 2"49 ; Milan, 1"9o ; New York, 1"81; Berlin, 1.76 ; Turin, 1"66; Dresden, 1"52 ; Amsterdam, 1"3o ; Hamburg, 1"26 ; Rotterdam, 1:21 ; Copenhagen, 1"14 ; T h e Hague, 1"12. In Australia we have the satisfactory figures of i'oo for Melbourne, and o'72 for Sydney. All the above towns show a steady decline in each quinquennium since 1881-1885. In London, the percentage of deaths at home as against deaths in public institutions (hospitals, homes and sanatoria, workhouses and lunatic asylums) was over fifty ill the following boroughs : Kensington, Hampstead, Paddington, Stoke Newington, Lambeth, Battersea, Wandsworth, Lewisham, and Woolwich. I11 nearly every London borough more females than males died at home. T h e proportion of deaths in public institutions was greater in those boroughs in which the conditions are such as to render more difficult the control of the disease, when the patient remains at home--e.g., in Holborn, which had the highest death-rate from phthisis, 7o'7 per cent. males and 60"9 females died away from home. The Registrar-General remarks : ~' It may fairly be urged that in districts (like Holborn) the conditions favour the spread of the disease so much that without segregation, the death-rate might well have been higher still." It is too early yet to comment upon any reduction in the mortality from phthisis in the three London boroughs of Paddington, Kensington, and Marylebone, in which Tuberculosis Dispensaries have been established, but there is every reason to hope that these dispensaries will have a marked effect in diminishing the mortality. In London most deaths have occurred between the ages of thirty and forty-five, both in males and females, but in females more ha'qe died under thirty than over forty-five; hence it appears that the power to resist the disease, as age advances, is less in females.