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of the disease, and in all probability others are already infected. The
extreme poverty of Poor Law patients adds again to the ordinary risks of
infection. A "family history in phthisis,'' recorded on 45 per cent. of
the cases visited, suggests a serious amount of domestic infection.
"In addition to the compulsory notification of Poor Law cases,
voluntary notification obtains in Westminster from Brompton and
Margaret Street Hospitals for Consumption, from the almoners of the
great general hospitals, and to some extent from the local dispensaries.
It also obtains from some private practitioners; but the class of patient
dealt with by the Society is seldom attended by a private doctor except
in an emergency, during an acute attack of the disease. The number
of patients in actual receipt of institutional treatment at any one time
is insignificant. It would therefore appear from the discrepancy
between the number of patients known to the Society and the number
of patients (850 exclusive of those from common lodging houses and
casuals) inferred on the lowest estimate by the Medical Officer of Health
from the number of deaths, that there are in Westminster a considerable
number of poor persons suffering from phthisis in their own homes,
presumably without medical treatment, certainly without any special
supervision from the public health authority, and without instructions
as to precautionary measures in the home. And as the more advanced
cases are those most likely to come to light, a considerable proportion
of those 'missed' patients are in all probability early cases—cases it
is most important not to miss !"
" Among these patients were a certain number of early cases, and here
the work of the Society has, on the whole, met with excellent results.
Patients first visited 1904-'05-'06, and since kept under observation, are
now reported ' keeping well,' 'at work'; and no further development of
the disease has been reported in the home. Many patients received institutional
treatment for periods ranging from a few weeks to a year,
obtained in co-operation with the Invalid Children's Aid Association, the
Charity Organisation Society, the Jewish Board of Guardians, and local
convalescent funds. It is interesting to note in this respect, that for
children (31 cases)—the majority early cases—and for young persons
15 to 20 years (39 cases), institutional treatment extending over many
months was almost invariably arranged for. Poverty is less extreme
here than in the Poor Law class; but, where needed, maintenance of
the family during the institutional treatment of the wage-earners, rent,
extra nourishment, clothing, spit-bottles, an extra bed, &c., were
arranged for, in co-operation with the Charity Organisation Society and
other charitable agencies."
"Brompton and Margaret Street Hospitals, the only agencies offering
special facilities for the examination of 'suspects,' are both outside the