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The animal reports give evidence of extension in London of the adoption of measures
designed for the control of tubercular disease. These measures include the voluntary notification,
of phthisis, the giving of advice as to the precautions which should be taken in the house of
the patient, especially as to the manner in which the sputum should be dealt with, and the
disinfection of the house which has been occupied by the patient either after death
or removal. A system of voluntary notification of phthisis has now. been adopted in the following
districts, and the number of cases notified is shown in some of the reports, thus—Kensington (221),
Hammersmith (143 since the 11th April, 1903), Fulham (171), Chelsea, Holborn, Westminster
(124 since the 6th April), Hampstead (37), Stoke Newington (52), Finsbury (115), City (4),
Southwark (307), Bermondsey (67 since the 24th April), Lambeth (339), Wandsworth (88), Greenwich
(51), Woolwich (167). Thus, in more than half the sanitary areas of London this system
existed in 1903, and in Holborn the borough council has since resolved to adopt the same course.
In Islington a proposal for this purpose was rejected, but Dr. Harris expresses the hope that the
matter will shortly be reconsidered.
Incidental to notification are inquiries into the supposed source of the infection and into
the family history of the patient. A few of the reports contain interesting information on both
these points, and the subject is discussed in the reports of the medical officers of health of
Westminster, Finsbury, Hampstead, Southwark, Bermondsey, Camberwell and Woolwich. The
question of the provision of sanatoria is also discussed in a number of annual reports, and the
Woolwich Borough Council has decided, as an experiment, to maintain two beds at the Peppardcommon
Sanatorium in Oxfordshire. The beds are now occupied by two men removed from
Woolwich. In a number of districts sputum was examined for tubercle bacilli at the cost of the
local authority.
The by-law of the London County Council prohibiting spitting in public places came
into force on the 12th May, 1903.
The by-law provides that "no person shall spit on the floor, side, or wall of any public
carriage, or any public hall, public waiting room, or place of public entertainment whether
admission thereto be obtained upon payment or not. Any person who shall offend against this
by-law shall be liable for each offence to a fine not exceeding forty shillings." Any person can
take steps for obtaining the enforcement of the penalty in the event of breach of the by-law.
The words "any public carriage" would include a railway carriage. Dr. Collingridge
includes in his annual report relating to the City an account of the steps taken on railway companies'
premises in the City, and in railway carriages, to cleanse the premises and carriages and
to exhibit cautionary notices against spitting.
Cancer.
The deaths from cancer in the administrative county of London during 1903 (52 weeks)
numbered 4,695, the annual average of the preceding ten years being 3,964.
The death-rates of this disease per 1,000 living in successive periods have been as follows—

For the purpose of enabling the incidence of cancer on the several populations of the
metropolitan boroughs to be more precisely stated, factors have been calculated for correcting,
as far as possible, for differences in the age and sex constitution of the several populations concerned.
These factors are shown in the following table, together with the death-rates for each
metropolitan borough, corrected by their application. Owing to the changes of area in the
sanitary districts of London, caused by the London Government Act of 1899, the death-ratee
since 1900 are the only figures available for comparative purposes, but it can be seen from these
figures that differences in the age and sex constitution of the population are partially responsible
for the differences in the crude death-rates obtaining in the several districts.
1 See footnote (2) page 7.
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