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notifiable under the Infectious Disease (Notification) Act, 1889, and
the Public Health (London) Act, 1891, are hardly applicable to Pulmonary
Tuberculosis. It is necessary, therefore, that special
methods should be applied to this disease, and the Board felt, as
they explained in a previous Circular-letter, that the objects in view
could be best attained if the procedure of compulsory notification were
by stages and by a gradual development of administrative machinery.
Accordingly in 1908 they issued regulations limiting the notification
to cases of Pulmonary Tuberculosis occurring among the inmates
of Poor Law institutions or amongst other persons under the care of
District Medical Officers. In March of last year further regulations
were made extending the system of notification to cases occurring
amongst the in-patients or out-patients at hospitals, or other similar
institutions, for the treatment of the sick, which are supported wholly
or partially otherwise than by the contributions of the patients (or of
their relatives or guardians) and otherwise than from rates and taxes.
The Public Health (Tuberculosis) Regulations, 1911, complete
the system of notification which was inaugurated in 1908, for after
January 1, 1912, it will be the duty of every Medical Practitioner to
notify within 48 hours every case of Pulmonary Tuberculosis occurring
in the course either of his public or of his private practice; but a
Medical Practitioner is relieved of the duty of notifying a case of Pulmonary
Tuberculosis which has to his knowledge already been notified
to the proper authority. The Order is not a consolidating Order, but
supplements and in some respects extends the Poor Law and Hospital
Regulations already issued.
It is worthy of note that the death-rate from Pulmonary Tuberculosis,
though still far higher than that resulting from any other
disease to which the principle of notification has hitherto been applied,
has, nevertheless, shown a marked decline in the last thirty years.
In 1881 the death-rate per 10,000 of the population was 18.25, in
1891 it was 15.99, in 1901 it was 12.64 and in 1909 it was 10.93.
This decrease has coincided with a marked increase in the activities