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The steps taken in London for the limitation of phthisis are in the main based upon the view
of the communicability of the disease from the sick to the healthy by means of the sputum. The
practice of voluntary notification of cases of phthisis is now adopted in the majority of London districts,
and during the year 1905 there was notification in 19 of the 29 sanitary areas of London. Thus there
was voluntary notification in—
Kensington St. Pancras Southwark
Hammersmith Islington Bermondsey
Fulham Stoke Newington Lambeth
Chelsea Holborn Wandsworth
< Westminster, City of Finsbury Greenwich
St. Marylebone London, City of Woolwich
Hampstead
The districts in which a system of voluntary notification of cases of phthisis had not been adopted
were—
Paddingtoti Stepney Deptford
Hackney Poplar Lewisham
Shoreditch Battersea
Bethnal Green Camberwell
The number of cases notified was small, ranging from 297 in Southwark to 24 in Chelsea.
In cases brought to the knowledge of the medical officers of health, advice was given as to the
precautionary measures which should be adopted in dealing with the sputum, as to the maintenance
of cleanliness in the home and as to ventilation of the rooms occupied by the patient. In cases in
which death occurred or in which there had been removal of the patient, the sanitary authority
undertook the disinfection of the room which he had occupied, whenever consent was given for the
purpose. It would appear that the public is, more than before, recognising the desirableness of
following the directions which are generally deemed to be necessary in cases of this disease. Thus
Dr. Newman states, with respect to 178 cases of phthisis in Finsbury brought to his knowledge by
means of voluntary notification, that he found precautions were already being taken in 62 cases, and
Dr. Reginald Dudfield states that as the result of inquiry in 112 cases in which death had taken place,
in only 26 did it appear that nothing had been done in the way of precautionary measures.
In some reports the number of cases is stated in which there had been exposure to antecedent
phthisis in the home. Dr. Davies states, that of 145 cases notified in Woolwich in 1905, 44 were
probably infected by relatives; Dr. Newman writes that 47 or 32*1 per cent, of the total deaths in
Finsbury occurred in homes already infected. A history of previous phthisis in the family was
obtained by Dr. Reginald Dudfield in 35 of 112 cases in Paddington.

and Dr. Keginald Dudneld writes that In one.room homes separate sleeping accommodation, except
where the home is occupied by one person only (there were 13 such homes) is impossible. In other
homes of all classes 11 of the deceased had separate bedrooms, and 26 others separate beds but not
separate bedrooms."
It is obvious that if administration is to be based upon the view that phthisis is communicable
from one person to another, the home conditions of persons attacked by phthisis should be
considered in the selection of cases for removal to hospital, and hence the necessity for bringing the
administration of sanitary authorities into relation with that of those authorities concerned with hospital
provision.
Dr. Louis Parkes includes in his report a table showing the death.rate from phthisis in 1893-6,
1897-1900 and 1901-4, in the Metropolitan Borough of Chelsea in industrial dwellings and in 11 poorclass
streets, and shows that the death-rate in Chelsea, as a whole, has decreased in the second and thiid
periods, and in industrial dwellings had diminished slightly in the third period ; whereas that of the
population of the poor streets had remained undiminished.
The following table shows the mortality from phthisis in groups of London sanitary districts
arranged in respect to the proportion of their population living more than two in a room in tenements
nf less than five rnnms

1 See footnote (1) page 16.