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Xonbon County Council
PULMONARY TUBERCULOSIS.
Report by the Medical Officer presenting a report by Dr. Wanklyn as to the Action
taken by London Sanitary Authorities with regard to cases of Pulmonary
Tuberculosis.
Public Health Department,
February, 1910.
The Committee instructed me in July last to inquire and report on the action which is being taken
in each of the sanitary areas of London with regard to cases of pulmonary tuberculosis coming to the
knowledge of the sanitary authorities. This inquiry was entrusted to Dr. Wanklyn, and I now present
his report in which will be found an account of proceedings in respect of cases of this disease in each
district.
It is convenient to consider in the first instance the sufficiency of the arrangements which exist
in London for cases of pulmonary tuberculosis to be made known to the Medical Officer of Health.
The Council has, during the last few years, urged sanitary authorities to adopt a system of
voluntary notification, and at the present time this system is in operation in every district in London
except Paddington, Shoreditch, Bethnal Green, Stepney, Poplar, Battersea, Camberwell and Deptford.
Under the Tuberculosis Order of the Local Government Board all cases of this disease occurring in
poor law practices are required to be notified to the medical officers of health, and such notifications
are received by the medical officers of health of the districts mentioned as well as of those in which
a system of voluntary notification has been adopted. Moreover, the Secretary of the Brompton
Hosiptal for Consumption has, since November, 1908, forwarded to me for distribution among the
medical officers of health the addresses of patients attending the hospital and who have given their
consent for this purpose. The certificates concerning these patients are communicated to the medical
officers of health concerned whether their authorities have adopted a system of voluntary notification
or not. A similar arrangement has since been made with the authorities of the Mount Vernon,
King's College, St. Mary's, Middlesex, Westminster and Royal Free Hospitals. In some other
instances the hospital authorities notify cases to the medical officer of health of the district in which
the hospital is situated.
Dr. Wanklyn has discussed the extent to which voluntary notification brings to the knowledge
of the medical officer of health cases of pulmonary tuberculosis and he shows that the number of cases
notified each year in the districts in which voluntary notification has been adopted falls short of the
number of deaths occurring. I may supplement the information contained in his report by the
following figures relating to sixteen districts for which the information is available and which include
cases occurring in poor law practices notified in 1909 under the regulations of the Local Government
Board :—

1814
a
Notifications
Voluntary,
1908.
2,642
Deaths,
1908.
3,714
Notifications obligatory
in poor law practices
and voluntary in other
practices.
" 6,368
Deaths,
1909.
3,592
The result of the Tuberculosis Order has been that the number of cases notified has been more than
loubled, but this number must still fall far short of the actual number of cases occurring. It may,
therefore, be considered whether obligatory notification of patients in all classes of the population
would produce very different results.
In a few provincial towns voluntary notification has been followed by compulsory notification.
I am indebted to the medical officers of health of three of these towns for information concerning the
number of cases notified under each system. The following table enables the figures obtained from
voluntary and compulsory notification in Bolton to be compared :—