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such diseases are highly infectious, and other things being equal, should
be notified. In the case of phthisis this does not appear to exist, in spite
of the harrowing pictures drawn by Koch and others of the great
danger to the remaining members of contracting a recognisable form of
phthisis from a person dying of this disease, which are used as arguments
for isolation of the advanced cases. It is not a common thing for second cases
to occur in the same house, but it is a common thing for other cases to
have occurred in members of the same family in other houses; and, lest it
should be thought that such immunity to other co-residents has come
about by precautionary measures being taken, I would point out to the
Council that it existed previous to 1898, when emphasis first began to be
laid on the theory of the extreme direct infectivity of this disease.
Since 1901 when we first began to ascertain the previous
addresses of those who had died in the various public institutions in the
Parish, I have been able to find out that a second death, in houses where a
previous death had occurred from the same disease, happened in 59
instances. Of these three were in common lodging-houses; in five cases
the second patient was ill on arrival; in 20 instances it was impossible to
obtain any information ; while in the remainder the deceased persons had
probably contracted the disease during their residence in the house. In
some of these instances there was a previous family history of consumption ;
and the following may be selected as fairly typical of other cases : — death
occurred in one instance after one year's illness, and two and a half years
after the first death ; another with a similar duration of illness, but three
and a half years after the first death.
For purposes of comparison I give the death rates for the
Boroughs of South London, distinguishing between those where
voluntary notification is in force and where it is not.
Metropolitan Boroughs south of the Thames where voluntary
notification of phthisis is carried out: —

(In his annual report for 1902 Sir Shirley Murphy states that a
system of voluntary notification had, among others, been started in
Lambeth, Southwark, Bermondsey, Greenwich, Wandsworth and Woolwich.)