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first time only at post mortem examination. Other reasons given for nonnotification
include difficulty of diagnosis and the belief by the medical practitioner
concerned that the case had already been notified by a doctor previously attending
the patient.
It is unfortunate that by a proviso in the Eegulations of 1912, a medical
practitioner is not required to notify a case of tuberculosis if he has reasonable
grounds for believing that the case has already been notified. It would seem that
any disadvantage accruing from duplication would be easily outweighed by the
advantage of the additional encouragement to promote early notification which
would ensue from the withdrawal of this proviso from the Regulations.
The Eegulations also require notification of the admission and discharge of
patients to poor law institutions and sanatoria. It has been found necessary
during the year to communicate with both classes of institution drawing attention
to the Eegulations and urging strict compliance therewith.
Institutional Treatment.
During the year notifications were received of 111 admissions to institutions.
These admissions represent 77 patients, some of whom are transferred from one
institution to another, and others are discharged, or take their own discharge,
and subsequently are re-admitted.

Thirty-four of these admissions were transfers from one institution to another
or re-admissions.
Visitation of Homes, etc.
Arrangements have been made for the home visitation of all non-Dispensary
cases by the Sanitary Inspectors. Any patients attending the Tuberculosis
Dispensary come under the care of the Tuberculosis Nurse; all others are re-visited
at least once a quarter by the Sanitary Inspectors in order to secure the proper
disposal of the sputum and the best use possible of the sleeping accommodation.
The visitation of tuberculosis patients is frequently rendered difficult because
the patients are away from home; in the early stages of the disease patients are
not necessarily kept from work and the proper visitation of such patients
frequently entails two or three calls by the Inspector or Visitor.
Owing to the migratory character of a fair proportion of the notified cases
it is somewhat difficult to keep the Tuberculosis Register of a district such as
Holborn correctly revised: a considerable number of visits by the staff must be
made for this purpose.
Contacts.
Contacts are invited to attend for examination at the Tuberculosis Dispensary.