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The annual reports show some increase of administrative measures in London designed for
the purpose of the control of tubercular disease. Thus a system of voluntary notification of such
disease has been established in the Cities of London and Westminster and in Bermondsey, Finsbury,
Greenwich, Hammersmith, Hampstead, Kensington, Lambeth, Southwark, Stoke Newington,
Wandsworth and Woolwich. In several of these districts there was notification during part
of the year only, and in a few arrangements for this purpose were not actually made until shortly
after the end of this year, so that only 1,191 cases were actually notified in London in 1902.
Several reports show that medical officers of health had recommended their authorities to institute
a system of voluntary notification of phthisis, and only one report shows that the medical officer
of health is opposed to this practice. Sanitary authorities are empowered, as shown by a letter
of the Local Government Board, to pay a fee to medical practitioners notifying cases, and the
amount paid for the notification of dangerous infectious diseases is that which has been adopted.
The notification has been followed by the offer of disinfection free of charge in cases of change of
residence or of death of the patient, the supply of leaflets giving advice as to care in dealing with
the sputum and other matters, and often by inquiries as to whether there is reason for thinking
that the disease has been contracted by exposure to another person suffering in a similar manner.
In a few reports information as to antecedent phthisis in other members of the family is given.
Thus in Finsbury Dr. Newman found that other members of the family had suffered from phthisis,
and might have been the source of infection of the patients concerned in 59 cases notified, and 15(i
cases of death, and in Woolwich in nine notified cases. In Hampstead a phthisical family history
was found in 17 of 41 cases, in Kensington in 104 of 247 cases. Dr. Newman moreover found by
inquiry into the history of 16 children in Finsbury who died from tabes-mesenlerica, that in seven
instances the child was in contact with a relative suffering from phthisis, in six instances either a
parent or brother or sister, and in three instances was in contact with a neighbour suffering from
that disease. Again, Dr. Davies, as the result of inquiry into the death of three children in Woolwich
from tubercular meningitis, found that "in two cases there was a person in the house recognised
to be suffering from phthisis, and in the third case a man suffering from chronic winter cough
and sputa, who refused to be examined as to whether or no he had phthisis." Disinfection after
death from phthisis or after removal from a house of a person so suffering has been carried out in
numerous cases. Bacteriological examinations of sputum from suspected cases of phthisis has given
positive results in 48 of 118 examined in Fulham, in 22 of 98 examined in Hampstead, in 108
of 212 examined in Lambeth, and in none of 9 examined in Westminster. In respect of many
districts the results were not stated. The parallelism between the incidence of phthisis and of
overcrowding in the London districts has been shown in earlier reports to the County Council.
Dr. Reginald Dudfield, in his annual report, shows that similar results are obtained when the
overcrowding and phthisis incidence of the different wards of Paddington are examined.
In 1900, at a conference of London poor law authorities, a resolution was adopted to the
effect that provision should be made for the open air treatment of cases of consumption among the
sick poor of the metropolis. In 1902, the Metropolitan Asylums Board received from their General
Purposes Committee the following report—
At the Board meeting on the 26th July last the Managers remitted to us for consideration and
report (in connection with other letters previously received on the same subject) a letter from the
Bermondsey Borough Council, in which they again urged the establishment by the Managers of
sanatoria for the treatment of consumptive persons, and forwarded an epitome of the replies received
from the other Metropolitan Borough Councils who had been asked to support their proposals.
This epitome showed that of the twenty-six councils who had been asked to support the action taken
by Bermondsey, ten approved of the proposal that the managers should provide sanatoria for the
treatment of consumptive patients, five approved of the principle of the need for open air treatment for
consumptives, but were not agreed as to the authority for carrying out the same, while the remaining
eleven had either taken no action in the matter or were not in favour of the proposal.
We have given due consideration to the whole question, but having regard to the important issues
involved, and to the fact that there is not yet a general consensus of opinion amongst the Metropolitan
authorities in favour of the Metropolitan Asylums Board undertaking the treatment of consumptive
patients, we have deferred consideration of the matter for twelve months.
The Board resolved that local authorities should be informed that in the absence of
unanimity of opinion among the authorities of the metropolis the consideration of the question
of the provision of accommodation for persons suffering from consumption should be adjourned for
twelve months.
For the limitation of the risk of infection from the sputum of persons suffering from pulmonary
phthisis, and for the prevention of the objectionable practice of spitting in public places,
the County Council has made a by-law under the Municipal Corporations Act of 1882, which is
as follows—
"No person shall spit on the floor, side, or wall of any public hall, public waiting-room,
or place of public entertainment, whether admission thereto be obtained upon payment or not."
It may be noted that the words "any public carriage" would include a railway carriage,
and that any person could take steps for obtaining the enforcement of the penalty in the event of
breach of the by-law.
Cancer.
The deaths from cancer in the administrative county of London during 1902 (53 weeks)
numbered 4,630, the corrected annual average for the preceding 10 years being 4,022.