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to them for seeing that the requirements of the Regulations
are fully observed in their districts, and stated that where
(as in the case of a death certified as due to tuberculosis of a
person who had not previously been notified under the Regulations)
there is prima facie evidence of neglect to notify on
the part of the medical attendant, immediate steps should be
taken by the Local Authority to obtain an explanation from
the medical attendant as to the circumstances under which
formal notification under the Regulations was not made. If
the explanation is not satisfactory, it should be borne in mind
that the Local Authority have power to institute proceedings
for the recovery of a penalty under Section 1 (3) of the Public
Health Act, 1896, in cases of wilful negleqt or refusal to carry
out the Regulations; and it appears to the Minister that it
may even be desirable to proceed to a prosecution in one or
two cases of the kind where the circumstances warrant such
action in order to secure the objects of the Regulations.
6. The attention of the Local Authority is drawn to the
second paragraph on page 2 of Circular 196, issued on the
21st April, 1921, in which it was pointed out that it is open
to a Local Authority to obtain from the Registrar of Births
and Deaths, on payment of the prescribed fees, returns of the
particulars registered concerning deaths from tuberculosis,
iiarly information as to deaths from tuberculosis, which could
be obtained by means of weekly returns from the Registrars,
is not only requisite for the purpose of the revision of the
Register of Notifications, which the District Medical Officer of
Health is required to keep under Article XI (2) of the Regulations
of 1912, but affords valuable information to the
Medical Officer of Health in regard to cases which may not
have been notified, e.g., for the purposes of taking any necessary
steps for the disinfection of premises, and of inquiry
into the reasons for the absence of a notification.
II.—Keeping of Registers and Census of Cases.
1. It is the duty of the Medical Officer of Health under
Article 4 of the Regulations of 1921 to remove from his
Register of Notifications the entries relating to notifications
in respect of persons who have, to his knowledge, died or have
ceased permanently to reside within the district. In order,
however, that the Register may contain as accurate a list as
possible of the cases of tuberculosis in the district, it is
desiraEle that there should also be removed from the Register
those cases in which after notification (a) the diagnosis of
tuberculosis is agreed not to be established, or (b) the patient
in due course attains a condition in which he may be regarded
as cured of the disease.
As regards (a), no case should be removed from the Register
except with the assent of the practitioner by whom it was