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(xi.) Patients suffering from Non-pulmonary Tuberculosis receive advice and treatment
from the Surgeons of St. Bartholomew's Hospital, to whom they are referred from the
Dispensary. Treatment in residential institutions is provided as for pulmonary cases. The
Corporation supplies surgical apparatus free of cost for necessitous residents in the City.
(xii.) The arrangements for " care " and " after care " are carried out by a subcommittee
of the Sanitary Committee, on which two ladies are co-opted as members.* It
receiver es detailed reports on all cases of Tuberculosis occurring among City residents.
(xiii.) No local arrangements exist for providing employment for patients.
(xiv.) No opportunity has arisen for the use of a shelter, but arrangements would be
made for any suitable case if a site were available.
(xv.) No special points have been noted as to the incidence of Tuberculosis ; the records
do not show that the disease is specially prevalent among any class of workers in the City.
(xvi.) The usual methods for preventing the spread of infection are adopted, and
pocket sputum flasks are provided free of cost.
(xvii.) The principal difficulty encountered occurs on the discharge of a patient from
a sanatorium with the disease quiescent. The home environment to which he returns is often
unsatisfactory ; suitable occupation near his home may be practically unobtainable, even
when remuneration is not the main consideration, and the very considerable benefit gained
is in some cases soon lost and the treatment in the sanatorium largely wasted.
(xviii.) Difficulties also arise with regard to advanced cases. These are usually very
infectious and do not care to go to the infirmary. It is hoped during the present year to make
arrangements for their reception in an advanced care home.
NOTIFICATION OF TUBERCULOSIS.— In August the Ministry of Health
issued a circular letter to medical practitioners throughout the country, directing
attention to the fact that the requirements of the Public Health (Tuberculosis)
Regulations, 1912, so far as they relate to the notification of persons suffering from
Tuberculosis, did not appear to be fully appreciated by certain practitioners.
It was stated that in certain districts more than 40 per cent, of the persons
dying from Tuberculosis had not been previously notified as suffering from that
disease.
Although no difficulty has been experienced in securing notification of City
cases, the Sanitary Committee considered it desirable, in view of the above Circular,
that a special communication should be addressed to the City practitioners by the
Medical Officer of Health asking them to ensure prompt notification in order that
it might be possible to deal with cases with the maximum of expedition.

Of the fifteen deaths recorded above, two or 13.3 per cent. referred to persons
who had not been notified as suffering from Tuberculosis. These two cases were both
Non-Pulmonary cases, one a baby of five months who had Tubercular Meningitis for
seven days only before death, and the other a lad of eighteen years whose death
was also certified to be due to Tubercular Meningitis. In both instances the disease
was not determined until after death.
* The present lady members of the Committee are Lady Cooper, O.B.E., and Miss Crosby. M.B.E.