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A similar table relating to Edinburgh may be presented, but it needs to be stated that the results
are not strictly comparable with those obtained in the other towns. During the last twenty years
there has existed in Edinburgh a " Dispensary for the Prevention of Consumption " which has been
instrumental in securing the notification of cases of this disease, and this fact may in part explain
the smallness in the increase of number of notifications as the result of obligatory requirement
to notify. The table does not enable distinction to be made between new cases and those previously
notified.

It appears therefore (a) that voluntary notification may fail to bring to the knowledge of the
medical officer of health as many cases of pulmonary tuberculosis as there are deaths from this disease ;
(6) that when voluntary notification is supplemented by obligatory notification of cases occurring
in poor law practices the number of notifications is materially increased, but that it does not bring to
knowledge more than a proportion of the clinically recognisable cases ; (c) that compulsory notification
of cases of this disease, whether occurring in poor law or other practices, brings to the knowledge
of the medical officer of health a number of cases in excess of the number of deaths, but, so far as
may be judged from the experience of the provincial towns mentioned, this number is still obviously
less than the number of the clinically recognisable cases.
The most important of the reasons why a system of notification whether voluntary or obligatory
fails to bring to knowledge more cases of pulmonary tuberculosis is that for such system to be effectual
the patient must feel that he will derive some benefit from it. In the absence of prospect of relief being
afforded him as the result of his illness being made known to the medical officer of health, he is unwilling
that his state of health should be disclosed. This, indeed, was the experience of Sheffield, of which
Dr. Scurfield, the medical officer of health, told me some two years ago, and quite recently he has
written to me in the same sense. Sheffield, therefore, opened a hospital for twenty male patients
in 1908 and twenty female patients in 1909.
It was to provide opportunity for the early detection of cases of pulmonary tuberculosis that the
physicians of Brompton Hospital have been willing during the last few years to examine, on the request
of the medical officer of health, any member of the family of a patient attending at the hospital and
whose state of health suggested the need for such examination. The proposal undoubtedly promised
to be useful, and I have invited other hospitals to adopt the same course. It is, however, necessary to
say that but little use has been made of the opportunity thus afforded by the Brompton Hospital,
as the scheme has not brought under treatment any considerable number of persons in the early
stages of this disease.
Appended to Dr. Wanklyn's report is a statement, relating to each sanitary district, showing
the steps which are taken in the interest of the patient and of those with whom he is associated
on receipt by the medical officer of health of notice that an inhabitant of his district is
suffering from pulmonary tuberculosis. These steps include visits to the house in one or two districts
by the Medical Officer of Health, but usually by a male or female sanitary inspector or health visitor,
and the giving of advice on a number of important points. In some districts, moreover, the
services of a local health society are available for rendering assistance to the patient and his
family, and for ensuring as far as possible the adoption of those prophylactic measures
which are deemed to be necessary. Provision is therefore made in some degree in some
districts for the supervision of the patient while he is in his own house. In some others the steps